Gastroesophageal reflux disease and Barrett's esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication.

TLDR: The incidence of EE and of BE in SG patients was considerably higher than that reported in the current literature, and it was not related to GERD symptoms, so endoscopic surveillance after SG should be advocated irrespective of the presence of GERD Symptoms.

About: This article is published in Surgery for Obesity and Related Diseases.The article was published on 2017-04-01 and is currently open access. It has received 294 citations till now. The article focuses on the topics: GERD & Sleeve gastrectomy.

Figures

Table 1 Preoperative versus postoperative GERD symptoms, PPI intake, and endoscopic findings

Table 2 Relationship between GERD symptoms and endoscopic findings after SG

Fig. 1. Study design. SG ¼ sleeve gastrectomy; EGD ¼ esophagogastroduodenoscopy.

Table 3 Effect of HHR versus no hiatal repair on GERD symptoms, PPI intake, and endoscopic findings after SG

Fig. 2. (A) Biliary-like esophageal reflux; (B) Upward migration of “Z” line; (C) Grade D erosive esophagitis; (D) Hemostatic clip placement after “Z” line biopsy.

Frequently asked questions

Q1. What have the authors contributed in "Gastroesophageal reflux disease and barrett’s esophagus after laparoscopic sleeve gastrectomy_ a possible, underestimated long-term complication" ?

In this paper, the authors show that there is no strict relationship between GERD symptoms and occurrence of EE and or of BE. 

Q2. How long did the patient stay on a semisolid diet?

Patients were discharged on a semisolid diet along with a 40 mg/d dose of PPI for the first 3 months, followed by 20 mg/d for the next 3 months. 

Q3. How many SGs were performed in 2012?

in the Fourth International Consensus Summit on SG in 2012, postoperative GERD was the most frequently reported complication in a collective seriesof 4 46,000 SGs performed by 130 surgeons worldwide, with a mean incidence of 7.9% [14]. 

Q4. How many cases of BE have been reported in Braghetto et al.?

Braghetto et al. recently reported a 1.2% incidence (3 cases) of BE in a cohort of 231 SG patients who did not suffer of reflux symptoms, HH, or BE before surgery [23]. 

Q5. Does highdose PPI intake prevent mucosal damage?

Highdosage PPI intake, while easing GERD symptoms, likely does not maintain gastric content pH consistently above 7 and, consequently, does not prevent mucosal damage. 

Q6. What are the main findings of the present series?

Results of the present series strongly suggest that careful endoscopic surveillance should be undertaken regardless of absence of reflux symptoms and of PPI intake. 

Q7. How did Gagner advocate a protective effect of SG on GERD?

Gagner advocated a protective effect of SG on GERD [25] by mentioning the series by Rebecchi et al., whose patients with preoperative pathologic reflux experienced a significant reduction of GERD symptoms, DeMeester score, and esophageal total acid exposure 24 months after the procedure [27]. 

Q8. How many patients had a mean migration length of 3.6 cm?

Upward migration of the “Z” line was registered in 81 patients (73.6%) with a mean migration length of 3.6 1.2 cm (range: 1–6 cm). 

Q9. How many patients were asymptomatic after SG?

Tai et al., in a series of 47 SG patients, reported that postoperative EE was present in 40.1% of patients, although they were asymptomatic [18].