Reflux, Sleeve Dilation, and Barrett’s Esophagus after Laparoscopic Sleeve Gastrectomy: Long-Term Follow-Up
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Laparoscopic sleeve gastrectomy (SG) has become the most frequently performed bariatric procedure worldwide. De novo reflux might impact patients’ quality of life, requiring lifelong proton pump inhibitor medication. It also increases the risk of esophagitis and formation of Barrett’s metaplasia. Besides weight regain, gastroesophageal reflux disease (GERD) is the most common reason for conversion to Roux-en-Y gastric bypass.
We performed 24-h pH metries, manometries, gastroscopies, and questionnaires focusing on reflux (GIQLI, RSI) in SG patients with a follow-up of more than 10 years who did not suffer from symptomatic reflux or hiatal hernia preoperatively.
From a total of 53 patients, ten patients after adjustable gastric banding were excluded. From the remaining 43, six patients (14.0%) were converted to RYGB due to intractable reflux over a period of 130 months. Ten out of the remaining non-converted patients (n = 26) also suffered from symptomatic reflux. Gastroscopies revealed de novo hiatal hernias in 45% of the patients and Barrett’s metaplasia in 15%. SG patients suffering from symptomatic reflux scored significantly higher in the RSI (p = 0.04) and significantly lower in the GIQLI (p = 0.02) questionnaire.
This study shows a high incidence of Barrett’s esophagus and hiatal hernias at more than 10 years after SG. Its results therefore suggest maintaining pre-existing large hiatal hernia, GERD, and Barrett’s esophagus as relative contraindications to SG. The limitations of this study—its small sample size as well as the fact that it was based on early experience with SG—make drawing any general conclusions about this procedure difficult.
KeywordsSleeve gastrectomy Reflux GERD Conversion to RYGB Long-term data
Compliance with Ethical Standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the research committee of the Vienna Medical University and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Conflict of Interest
The authors DM Felsenreich, R Kefurt, M Schermann, P Beckerhinn, I Kristo, M Krebs, G Prager, and FB Langer declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.
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