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Obesity Surgery

, Volume 29, Issue 1, pp 207–214 | Cite as

Correlation Between Symptomatic Gastro-Esophageal Reflux Disease (GERD) and Erosive Esophagitis (EE) Post-vertical Sleeve Gastrectomy (VSG)

  • Chin Hong Lim
  • Phong Ching Lee
  • Eugene Lim
  • Jeremy Tan
  • Weng Hoong Chan
  • Hong Chang Tan
  • Sonali Ganguly
  • Kwang Wei Tham
  • Alvin Eng
Original Contributions

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) has become the preferred bariatric procedure in many countries. However, there is one shortcoming of LSG in the long-term follow-up and this is the onset of GERD and erosive esophagitis (EE). Current evidence of the effect of SG on GERD did not consolidate to a consensus. In this study, we objectively evaluate the incidence of EE 1 year post-LSG with upper endoscopy (EGD) and try to identify the significant variables and possible underlying mechanisms of the EE post-LSG.

Methods

Over a period of 5 years (2011–2016) at Singapore General Hospital, we retrospectively reviewed a prospectively collected database of a cohort of patients whom had LSG by a single surgeon who routinely performed EGD pre-operative and 1 year post-operative to assess EE and hiatal hernia. Patient’s endoscopic findings and demographic and anthropometric data were analyzed.

Results

We identified a total of 97 obese patients who underwent LSG at our hospital by studied surgeon. Sixty-three patients (64.9% of original sample) were finally evaluated in the present study, 40 (59.7%) of whom were female. The mean (range) age of patients was 38.2 (18–66) years, and mean BMI was 36.3 ± 4.1 kg/m2. Median time to follow-up EGD was 13 months (range, 12–15). Following LSG, there was a significant decrease in both BMI (42.1 ± 1.2 vs. 29.9 ± 1.0 kg/m2) and percentage excess weight loss of 56.6 ± 3.6%. The prevalence of EE on endoscopy increased from 9 (14.3%) to 28 (44.4%) patients. Of which 15 (23.8%) were grade A, 11 (17.5%) were grade B, and 2 (3.2%) were grade C. There was no correlation between GERD symptoms with EE; however, our study found a trend suggesting higher prevalence of EE with a sleeve diameter measuring > 2 cm wide (p = 0.069).

Conclusion

Although LSG is effective in treating obesity and its metabolic syndromes, the prevalence of EE increased significantly 1 year after the surgery. Since we do not fully understand the long-term impact of chronic esophagitis in post-sleeve population, we recommend follow-up EGD assessment post-operatively and treat the esophagitis if present.

Keywords

Gastro-esophageal reflux disease Erosive esophagitis Vertical sleeve gastrectomy Sleeve diameter Upper endoscopy 

Notes

Compliance with Ethical Standards

Conflict of Interest Statement

Author 1, author 2, author 3, author 4, author 5, author 6, author 7 & author 8 have nothing to disclose.

Ethics Approval Statement

For this type of retrospective study, formal consent is not required.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Upper Gastrointestinal & Bariatric Surgery, Division of SurgerySingapore General HospitalSingaporeSingapore
  2. 2.Department of Endocrinology, Division of MedicineSingapore General HospitalSingaporeSingapore

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