Skip to main content
SpringerLink
Log in

Hypotonic Low Esophageal Sphincter Is Not Predictive of Gastroesophageal Reflux Disease After Sleeve Gastrectomy

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Sleeve gastrectomy is the most commonly performed bariatric surgery these days but is associated with de novo reflux.

Objective

We aimed to study the influence of hypotonic lower esophageal sphincter (LES) on postoperative gastroesophageal reflux disease (GERD).

Methods

Patients with pre- and postoperative esophageal high-resolution manometry (HRM) and 24-h pH monitoring (pHM) were included retrospectively in our study. Preoperative hypotonic LES was defined by a mean residual pressure of the lower esophageal sphincter < 4 mmHg. Postoperative GERD was defined by a DeMeester’s score > 14.72. We also evaluated postoperative manometric changes at the esophageal-gastric junction.

Results

Sixty-nine patients (54 females and 15 males) had pre- and postoperative HRM and pHM. The mean age was 45.9 ± 9.8 years. The mean body mass index (BMI) was 47.5 ± 7.5 kg/m2. Hypotonic LES concerned 21 patients (30.4%) before sleeve gastrectomy. The mean time between the two esophageal monitorings was 32.1 ± 24.1 months. The sensitivity, specificity, positive predictive value, and negative predictive value of hypotonic LES to predict GERD were 31, 70, 52, and 48% respectively. The LES minimal residual pressure was not statistically decreased after sleeve gastrectomy (p = 0.24). Only the wave speed, esophageal length, and LES length were significantly reduced after SG (p = 0.029, 3.8 × 10−7 and 0.00032).

Conclusion

Hypotonic LES has a poor predictive value on postoperative GERD. The LES’s length is significantly reduced after SG and this could be a factor explaining de novo reflux.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Liu L, Li S, Zhu K, et al. Relationship between esophageal motility and severity of gastroesophageal reflux disease according to the Los Angeles classification. Medicine. 2019;98(19):e15543.

    Article  Google Scholar 

  2. Eusebi LH, Fuccio L, Bazzoli F. The role of obesity in gastroesophageal reflux disease and Barrett’s esophagus. Dig Dis. 2012;30(2):154–7.

    Article  Google Scholar 

  3. Angrisani L, Santonicola A, Iovino P, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;

  4. Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis. 2017;13(4):568–74.

    Article  Google Scholar 

  5. Sebastianelli L, Benois M, Vanbiervliet G, et al. Systematic endoscopy 5 years after sleeve gastrectomy results in a high rate of Barrett’s esophagus: results of a multicenter study. Obes Surg. 2019;29(5):1462–9.

    Article  Google Scholar 

  6. Felsenreich DM, Langer FB, Prager G. Weight loss and resolution of comorbidities after sleeve gastrectomy: a review of long-term results. Scand J Surg. 2019;108(1):3–9.

    Article  CAS  Google Scholar 

  7. Soricelli E, Casella G, Baglio G, et al. Lack of correlation between gastroesophageal reflux disease symptoms and esophageal lesions after sleeve gastrectomy. Surg Obes Relat Dis. 2018;14(6):751–6.

    Article  Google Scholar 

  8. Thereaux J, Barsamian C, Bretault M, et al. pH monitoring of gastro-oesophageal reflux before and after laparoscopic sleeve gastrectomy. Br J Surg. 2016;103(4):399–406.

    Article  CAS  Google Scholar 

  9. Haute Autorité de Santé - Obésité: prise en charge chirurgicale chez l’adulte. [cité 18 juill 2017]. Disponible sur: https://www.has-sante.fr/portail/jcms/c_765529/fr/obesite-prise-en-charge-chirurgicale-chez-l-adulte

  10. Johnson LF, Demeester TR. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974;62(4):325–32.

    CAS  PubMed  Google Scholar 

  11. Kasyap AK, Sah SK, Chaudhary S. Clinical spectrum and risk factors associated with asymptomatic erosive esophagitis as determined by Los Angeles classification: a cross-sectional study. PLoS One. 2018;13(2):e0192739.

    Article  Google Scholar 

  12. Alvarez Herrero L, Curvers WL, van Vilsteren FG, et al. Wong Kee Song LM, et al. Validation of the Prague C&M classification of Barrett’s esophagus in clinical practice. Endoscopy. 2013;45(11):876–82.

    Article  Google Scholar 

  13. Gagner M, Hutchinson C, Rosenthal R. Fifth International Consensus Conference: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(4):750–6.

    Article  Google Scholar 

  14. Braghetto I, Lanzarini E, Korn O, et al. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg. 2010;20(3):357–62.

    Article  Google Scholar 

  15. Del Genio G, Tolone S, Limongelli P, et al. Sleeve gastrectomy and development of “de novo” gastroesophageal reflux. Obes Surg. 2014;24(1):71–7.

    Article  Google Scholar 

  16. McGlone ER, Gupta AK, Reddy M, et al. Antral resection versus antral preservation during laparoscopic sleeve gastrectomy for severe obesity: systematic review and meta-analysis. Surg Obes Relat Dis. 2018;14(6):857–64.

    Article  Google Scholar 

  17. Wang Y, Yi XY, Gong LL, et al. The effectiveness and safety of laparoscopic sleeve gastrectomy with different sizes of bougie calibration: a systematic review and meta-analysis. Int J Surg. 2018;49:32–8.

    Article  Google Scholar 

  18. Mion F, Tolone S, Garros A, et al. High-resolution impedance manometry after sleeve gastrectomy: increased intragastric pressure and reflux are frequent events. Obes Surg. 2016;26(10):2449–56.

    Article  Google Scholar 

  19. Pallati PK, Shaligram A, Shostrom VK, et al. Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: review of the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2014;10(3):502–7.

    Article  Google Scholar 

  20. DuPree CE, Blair K, Steele SR, et al. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surg. 2014;149(4):328–34.

    Article  Google Scholar 

  21. Peterli R, Wolnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. Jama. 2018;319(3):255–65.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l’Appareil Digestif (IMAD), Centre Hospitalier Universitaire (CHU) Nantes-Hôtel Dieu, Nantes, France

    T. Greilsamer, M. de Montrichard, N. Regenet, E. Mirallié & C. Blanchard

  2. Institut des Maladies de l’Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Place Alexis Ricordeau, 44093, Nantes, France

    T. Greilsamer, M. de Montrichard, S. Bruley des Varannes, N. Regenet, E. Mirallié & C. Blanchard

  3. Department of Endocrinology, CHU de Nantes, Nantes, France

    D. Jacobi & M. Guillouche

  4. L’institut du thorax, Inserm, CNRS, Université de Nantes, Nantes, France

    D. Jacobi & C. Blanchard

Authors
  1. T. Greilsamer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. de Montrichard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Bruley des Varannes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Jacobi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Guillouche
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. N. Regenet
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. Mirallié
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. Blanchard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Greilsamer.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Statement

The study was reviewed by the local institutional review board according to the Helsinki Declaration.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Greilsamer, T., de Montrichard, M., Bruley des Varannes, S. et al. Hypotonic Low Esophageal Sphincter Is Not Predictive of Gastroesophageal Reflux Disease After Sleeve Gastrectomy. OBES SURG 30, 1468–1472 (2020). https://doi.org/10.1007/s11695-019-04335-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-019-04335-z

Keywords

Search

Navigation