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Meta-analysis of Long-term De Novo Acid Reflux–Related Outcomes Following Sleeve Gastrectomy: Evidence Against the Need for Routine Postoperative Endoscopic Surveillance

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Abstract

Objectives

To evaluate the incidence of long-term de novo acid reflux–related complications following sleeve gastrectomy (SG) to determine whether routine postoperative surveillance endoscopy is necessary.

Methods

A systematic search of Medline, Embase, CINAHL, CENTRAL, the Web of Science, and bibliographic reference lists was conducted. A proportion meta-analysis model was constructed to quantify the risk of the de novo gastro-oesophageal reflux disease (GORD), oesophagitis, and Barrett’s oesophagus (BE) at least 4 years after SG. Random-effects modelling was applied to calculate pooled outcome data.

Results

Thirty-two observational studies were included reporting a total of 7904 patients who underwent primary SG and were followed up for at least 4 years. The median follow-up period was 60 months (48–132). Preoperative acid-reflux symptoms existed in 19.1% ± 15.1% of the patients. The risk of development of de novo GORD, oesophagitis, and BE after SG was 24.8% (95% CI 18.6–31.0%), 27.9% (95% CI 17.7–38.1%), and 6.7% (95% CI 3.7–9.7%), respectively. The between-study heterogeneity was significant in all outcome syntheses. It was suspected that several of the included studies have not reported BE and oesophagitis because such events might not have happened in their cohorts.

Conclusions

Long-term risk of de novo GORD after SG seems to be comparable with those of the general population which questions the merit of surveillance endoscopy after SG in asymptomatic patients. De novo BE and oesophagitis after SG have not been reported by most of the available studies which may lead to overestimation of the rates of both outcomes in any evidence synthesis. We recommend endoscopic surveillance for symptomatic patients only.

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Authors and Affiliations

  1. Department of General Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK

    Shahin Hajibandeh, Nader Ghassemi, Daisy Evans & Chandra V. N. Cheruvu

  2. Department of General Surgery, University Hospital of Wales, Cardiff, UK

    Shahab Hajibandeh

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  1. Shahin Hajibandeh
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Correspondence to Chandra V. N. Cheruvu.

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Considering the design of our study, ethical approval and consent were not required.

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Shahin Hajibandeh and Shahab Hajibandeh equally contributed to this paper, and joint first authorship is proposed

Appendix 1: Included study data and characteristics of the included populations

Appendix 1: Included study data and characteristics of the included populations

Search no

Search strategy*

#1

MeSH descriptor: [Barrett’s esophagus] explode all trees

#2

Barrett’s oesophagus: TI,AB,KW

#3

MeSH descriptor: [Barrett’s oesophagus] explode all trees

#4

Barrett’s oesophagus: TI,AB,KW

#5

MeSH descriptor: [gastroesophageal reflux disease] explode all trees

#6

Gastroesophageal reflux disease: TI,AB,KW

#7

MeSH descriptor: [GERD] explode all trees

#8

GERD: TI,AB,KW

#9

MeSH descriptor: [gastro-oesophageal reflux disease] explode all trees

#10

Gastro-oesophageal reflux disease: TI,AB,KW

#11

MeSH descriptor: [GORD] explode all trees

#12

GORD: TI,AB,KW

#13

#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12

#14

MeSH descriptor: [sleeve gastrectomy] explode all trees

#15

Sleeve gastrectomy: TI,AB,KW

#16

#14 OR #15

#17

#13 AND #16

  1. *This search strategy was adopted for the following databases: Medline, Embase, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science

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Hajibandeh, S., Hajibandeh, S., Ghassemi, N. et al. Meta-analysis of Long-term De Novo Acid Reflux–Related Outcomes Following Sleeve Gastrectomy: Evidence Against the Need for Routine Postoperative Endoscopic Surveillance. Curr Obes Rep 12, 395–405 (2023). https://doi.org/10.1007/s13679-023-00521-4

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