Is Laparoscopic Sleeve Gastrectomy Linked to Gastroesophageal Reflux Disease?

Medical professionals performing laparoscopic surgery. Surgeons are with patient in operating room. They are holding surgical equipment.
Researchers sought to evaluate the incidence of gastroesophageal reflux disease following sleeve gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) showed limited refluxogenic nature when gastroesophageal reflux disease (GERD) diagnosis was based on the Lyon consensus at 3-year follow-up; moreover, patients who underwent LSG demonstrated significant improvement in QOL, according to study results published in Surgery.

Researchers retrospectively reviewed the clinical records of 52 patients (47 women and 5 men; median age, 43 years) with severe obesity who underwent LSG between January 2018 and November 2018. At the end of the 3-year follow-up period, the patients underwent screening endoscopy, and those with suspected postoperative esophagitis were submitted for endoscopic biopsies and pH-impedance monitoring.

Prior to the analysis, patients were instructed to have a “usual” day and to record the time and content of meals. They were also asked to record the time of upright and recumbent periods, time of administration of acid-suppressive medication, and the time of GERD symptoms.

Using a modified clinical DeMesteer score questionnaire, the researchers assessed for GERD when the presence of 3 symptoms were reported: dysphagia, regurgitation, and heartburn. A score from 0 to 3 was attributed to each symptom to determine severity, and GERD was suspected if the final score was greater than 3. The Bariatric Analysis and Reporting Outcome System score and 36-Item Short Form Health Survey were used to assess the postoperative QOL.

In the preoperative work-up, only 4 (7.6%) patients had signs of esophagitis at esophagogastroduodenoscopy. At 3-year follow-up, 50% of patients had endoscopic signs of GERD. Only 21 patients agreed to undergo pH-impedance monitoring, and the analysis only revealed the presence of GERD in 5 of those patients. Further, the median DeMesteer score questionnaire was 4.5, with only 4 patients (19%) exhibiting a value greater than the pH cut-off value (14.72), indicative of GERD. In the QOL analysis, 50% of patients reported an excellent score on the Bariatric Analysis and Reporting Outcome System, and all 8 domains from the 36-Item Short Form Health Survey improved significantly.

Limitations of the study included its retrospective nature, as well as the small sample size available for esophageal pH monitoring.

“In conclusion, this study showed improvement in QOL and the limited refluxogenic nature of LSG at 3-year follow-up, when the diagnosis of GERD is based on the Lyon consensus definitions,” the study authors noted. “The high prevalence of grade A esophagitis was insufficient to make a diagnosis of GERD, underlining the importance of MII-pH for discriminating simple esophagitis against GERD . . . The lack of objective pH data in the literature increases the possibility of an improper diagnosis of postoperative GERD. The limited refluxogenic nature, together with the low incidence of GERD symptoms and the improvement of QOL following LSG, may lead to an extension of current surgical indications.”

Reference

Tomasicchio G, D’abramo FS, Rigers D, et al. Gastroesophageal reflux after sleeve gastrectomy. Fact or fiction? Surgery. 2022;172(3):807-812. doi:10.1016/j.surg.2022.04.040