Gastroesophageal reflux disease after biliopancreatic diversion-duodenal switch: a systematic review and meta-analysis

Abstract

Introduction: Biliopancreatic diversion-duodenal switch (BPD-DS) procedures are being performed more often for patients with higher metabolic burden. These patients routinely get a concomitant sleeve gastrectomy. However, the effect on postoperative GERD has not been clearly elucidated.

Methods: We performed a systematic review and meta-analysis assessing the course of postoperative GERD in patients undergoing BPD-DS using a random effects model with restricted maximum likelihood. A comprehensive search of Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, and Cochrane Library (via Wiley) was performed. Included studies discussed BPD-DS, postoperative GERD or related outcomes and had a sample size > 5.

Results: Of 618 unique results, 14 studies were included, containing 1832 patients. Mean age and initial BMI were 44.6 and 51.2. Most patients were female (71%) and underwent a primary procedure (82%). Mean follow-up was 51.2 months. On single-arm pooled proportions analysis, 18% of BPD-DS patients had de-novo disease (95%CI 9 to 36%; 99/641). Of patients with pre-existing GERD, 49% had improvement or resolution (95%CI 33 to 64%; 224/543) and 14% had worsening of GERD (95%CI - 2% to 14%; 6/99). Compared to BPD-DS, GERD improvement was less likely for SG (OR 0.11, 95% CI 0.02-0.57), but more likely for RYGB (OR 2.06, 95%CI 1.16-3.66). There was no statistical difference in de-novo GERD between RYGB and BPD-DS (OR 1.05, 95%CI 0.50-2.23) or between SADI and BPD-DS (OR 1.71, 95%CI 0.70-1.71).

Conclusion: BPD-DS may have an overall beneficial effect on the postoperative trajectory of GERD. However, there is a notable proportion of patients who may develop de-novo GERD. GERD improvement following BPD-DS is more likely than following SG alone but remains inferior to RYGB for GERD alleviation. Future studies should assess the role of postoperative screening and the impact of concomitant fundoplication repair on patients undergoing BPD-DS.

Keywords: Bariatric surgery; Biliopancreatic diversion-duodenal switch; Gastroesophageal reflux disease.