Electrical stimulation of the lower esophageal sphincter to address gastroesophageal reflux disease after sleeve gastrectomy

Surg Obes Relat Dis. 2018 May;14(5):611-615. doi: 10.1016/j.soard.2018.02.006. Epub 2018 Feb 26.

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) can result in de novo and worsen preexisting gastroesophageal reflux disease (GERD). Post-LSG patients with GERD refractory to proton pump inhibitors (PPI) usually undergo more invasive, anatomy-altering Roux-en-Y gastric bypass surgery. Lower esophageal sphincter (LES) electrical stimulation (ES) preserves the anatomy and has been shown to improve outcomes in GERD patients.

Objective: To evaluate the safety and efficacy of LES-ES in post-LSG patients with GERD not controlled with maximal PPI therapy.

Setting: Prospective, international, multicenter registry.

Methods: Patients with LSG-associated GERD partially responsive to PPI underwent LES-ES. GERD outcomes pre- and poststimulation were evaluated based on quality of life, esophageal acid exposure (after 6-12 mo), and PPI use.

Results: Seventeen patients (11 female, 65%), treated at 6 centers between May 2014 and October, 2016 with a median follow-up of 12 months (range 6-24), received LES-ES. Median age was 48.6 years (interquartile range, 40.5-56), median body mass index 31.7 kg/m2 (27.9-39.3). All patients were on at least daily PPI preoperatively; at last follow-up, 7 (41%) were completely off PPI, 5 (29%) took PPI on an intermittent basis, and 5 (29%) were on single-dose PPI. Median GERD-health-related quality of life scores improved from 34 (on-PPI, 25-41) at baseline to 9 (6-13) at last follow-up (off-PPI, P<.001). Percentage of time with esophageal pH<4 improved from 13.2% (3.7-30.7) to 5.8% (1.1-54.4), P = .01.

Conclusion: LES-ES in post-LSG patients suffering from symptomatic, PPI-refractory GERD resulted in significant improvement of GERD-symptoms, esophageal acid exposure, and need for PPI. Preserving the post-LSG anatomy, it offers a valid option for patients unable or unwilling to undergo Roux-en-Y gastric bypass surgery.

Keywords: Bariatric surgery; Electric stimulation therapy; Esophageal pH; Gastroesophageal reflux; Lower esophageal sphincter; Postgastrectomy syndromes; Prospective studies; Proton Pump Inhibitors; Quality of life; Sleeve gastrectomy.

Publication types

  • Evaluation Study
  • Multicenter Study

MeSH terms

  • Adult
  • Bariatric Surgery / adverse effects*
  • Electric Stimulation Therapy / methods*
  • Esophageal Sphincter, Lower*
  • Female
  • Gastrectomy / adverse effects*
  • Gastroesophageal Reflux / therapy*
  • Humans
  • Laparoscopy / adverse effects*
  • Male
  • Middle Aged
  • Obesity, Morbid / surgery
  • Postgastrectomy Syndromes / etiology
  • Postgastrectomy Syndromes / therapy
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy
  • Prospective Studies
  • Quality of Life
  • Treatment Outcome