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Pepsin in saliva for the diagnosis of erosive esophagitis post-sleeve gastrectomy: a prospective observational study

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Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) has become the preferred bariatric procedure in many countries. However, new onset erosive esophagitis (EE) is a major shortcoming. Current recommendation is esophago-gastro-duodenoscopy (EGD) should be performed routinely at 1 year and subsequently every 2–3 years to enable the early detection of Barrett’s or esophageal adenocarcinoma. This would put significant strains on resources and costs of bariatric program. Our study assesses the association between and diagnostic value of salivary pepsin concentration and endoscopically proven EE in post-LSG patients as a surrogate for EGD.

Methods

Twenty patients on routine post-LSG endoscopy between June and September 2022 were recruited for this correlational pilot study. Under supervision, fasting and post-prandial saliva sample was collected and analyzed by Peptest lateral flow device. EGD examinations were performed, and patients completed a validated 25-item QoLRAD questionnaire.

Results

We found a significant correlation between positive endoscopy findings of EE and salivary pepsin concentrations. The normal group had a lower mean fasting pepsin level (13.13 ng/mL ± 18.97) versus the EE-group (90.55 ng/mL ± 81.28, p = 0.009) and lower mean post-prandial pepsin level (30.50 ng/mL ± 57.72) versus the EE-group (135.09 ng/mL ± 130.17, p = 0.02). The predictive probabilities from the binary regression of fasting and post-prandial pepsin concentrations yield AUC of 0.955 ± 0.044 (95% CI 0.868 to 1.000, p < 0.001).

Conclusion

Our study distinctively identified salivary pepsin to have excellent sensitivity and negative predictive value in EE, potentially useful to preclude the need for post-LSG EGD in asymptomatic patients with low salivary pepsin.

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Funding

This work is supported by SGH Health Development Fund (FZGRBARSUR).

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Authors and Affiliations

  1. Duke-NUS Medical School, SingHealth, Singapore, Singapore

    Jinyuan Gan & Yarn Kit Chan

  2. Division of Surgery, Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore, Singapore

    Deepa Chandra Segaran, Alvin Eng, Jeremy Tan & Chin Hong Lim

  3. Division of Medicine, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore

    Jean-Paul Kovalik & Phong Ching Lee

  4. Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore

    Chin Hong Lim

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  1. Jinyuan Gan
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Correspondence to Chin Hong Lim.

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Jinyuan Gan, Yarn Kit Chan, Deepa Chandra Segaran, Jean-Paul Kovalik, Alvin Eng, Phong Ching Lee, Jeremy Tan, and Chin Hong Lim have no conflict of interest or financial ties to disclose.

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Written informed consent was obtained from all patients for recruitment into this study.

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Gan, J., Chan, Y.K., Segaran, D.C. et al. Pepsin in saliva for the diagnosis of erosive esophagitis post-sleeve gastrectomy: a prospective observational study. Surg Endosc 37, 5816–5824 (2023). https://doi.org/10.1007/s00464-023-10050-9

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