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Valentini DF, Mazzini GS, Lazzarotto-da-Silva G, Simões AB, Gazzi VS, Alves JBO, Campos VJ, Gurski RR. Significant and distinct impacts of sleeve gastrectomy and Roux-en-Y gastric bypass on esophageal acid exposure, esophageal motility, and endoscopic findings: a systematic review and meta-analysis. J Gastrointest Surg 2024; 28:1546-1557. [PMID: 38901554 DOI: 10.1016/j.gassur.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/24/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND The lack of standardized objective assessment of esophageal physiology and anatomy contributes to controversies regarding the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on gastroesophageal reflux disease. This study aimed to investigate esophageal acid exposure, esophageal motility, and endoscopic findings before and after SG and RYGB. METHODS This was a systematic review and meta-analysis of studies reporting at least 1 objective measure of esophageal physiology and/or esophagogastroduodenoscopy (EGD) at baseline and after SG or RYGB. The changes in pH test, manometry, and EGD parameters were summarized. RESULTS Acid exposure time (AET) and DeMeester score (DMS) significantly increased after SG (mean difference [MD]: 2.1 [95% CI, 0.3-3.9] and 8.6 [95% CI, 2.0-15.2], respectively). After RYGB, both AET and DMS significantly decreased (MD: -4.2 [95% CI, -6.1 to -2.3] and -16.6 [95% CI, -25.4 to -7.8], respectively). Lower esophageal sphincter resting pressure and length significantly decreased after SG (MD: -2.8 [95% CI, -4.6 to -1.1] and -0.1 [95% CI, -0.2 to -0.02], respectively). There were no significant changes in esophageal manometry after RYGB. The relative risks of erosive esophagitis were 2.3 (95% CI, 1.5-3.5) after SG and 0.4 (95% CI, 0.2-0.8) after RYGB. The prevalence rates of Barrett esophagus changed from 0% to 3.6% after SG and from 2.7% to 1.4% after RYGB. CONCLUSION SG resulted in the worsening of all objective parameters, whereas RYGB resulted in the improvement in AET, DMS, and EGD findings. Determining the risk factors associated with these outcomes can help in surgical choice.
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Affiliation(s)
- Dirceu F Valentini
- Postgraduate Program in Medicine: Surgical Sciences, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Division of Gastrointestinal Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Guilherme S Mazzini
- Division of Bariatric and Gastrointestinal Surgery, Virginia Commonwealth University, Richmond, VA, United States
| | - Gabriel Lazzarotto-da-Silva
- Postgraduate Program in Medicine: Surgical Sciences, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Division of Gastrointestinal Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Arthur B Simões
- School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vitória S Gazzi
- School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Julia B O Alves
- School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vinicius J Campos
- Division of Gastrointestinal Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Richard R Gurski
- Postgraduate Program in Medicine: Surgical Sciences, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Division of Gastrointestinal Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Scott J, Blackhurst D, Hodgens BD, Carbonell AM, Cobb WS, Richardson ES, Dahlgren NJ, Kothari SN. Use of Preoperative Endoscopic Capsule-Based pH Testing Before Bariatric Surgery. J Am Coll Surg 2024; 238:551-558. [PMID: 38230854 DOI: 10.1097/xcs.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Vertical sleeve gastrectomy is the most performed bariatric operation in the US; however, a significant number of patients suffer from persistent or new-onset reflux. No consensus for objective preoperative evaluation in these patients exists. We compared capsule-based pH testing vs GERD symptom scoring to determine extent of preoperative GERD to aid in procedure selection for bariatric surgery. STUDY DESIGN An IRB-approved retrospective review of consecutive patients at a single institution was performed from April 2021 to December 2022. During initial consultation for bariatric surgery, a validated GERD symptom subjective survey was administered. All patients demonstrating interest in sleeve gastrectomy or had a history of reflux underwent upper endoscopy with capsule-based pH testing. RESULTS Sixty-two patients underwent preoperative endoscopy with capsule-based pH testing and completed GERD symptom assessment survey(s). Median BMI was 43.4 kg/m 2 and 66.1% of patients were not taking a proton-pump inhibitor before performance of pH testing. There was negligible linear association between the objective DeMeester score obtained by capsule-based pH probe and GERD symptom survey scores. Median GERD symptom survey scores did not differ between patients with and without a diagnosis of GERD based on pH testing (all p values >0.11). CONCLUSIONS An objective method for identifying severe GERD in the preoperative assessment may aid in the decision tree for procedure selection and informed consent process. Patients with significant preoperative GERD may be at higher risk for future GERD-related sleeve complications. Capsule-based pH testing may prove to be superior to subjective symptom scoring systems in this patient population.
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Affiliation(s)
- John Scott
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Dawn Blackhurst
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Brian D Hodgens
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Alfredo M Carbonell
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - William S Cobb
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Emily S Richardson
- University of South Carolina School of Medicine Greenville, Greenville, SC (Richardson)
| | - Nicholas Jp Dahlgren
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Shanu N Kothari
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
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Fernández-Ananín S, Balagué Ponz C, Sala L, Molera A, Ballester E, Gonzalo B, Pérez N, Targarona EM. Gastroesophageal reflux after sleeve gastrectomy: The dimension of the problem. Cir Esp 2023; 101 Suppl 4:S26-S38. [PMID: 37952718 DOI: 10.1016/j.cireng.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/28/2023] [Indexed: 11/14/2023]
Abstract
Sleeve gastrectomy is a safe and effective bariatric surgery in terms of weight loss and longterm improvement or resolution of comorbidities. However, its achilles heel is the possible association with the development with the novo and/or worsening of pre-existing gastroesophageal reflux disease. The anatomical and mechanical changes that this technique induces in the esophagogastric junction, support or contradict this hypothesis. Questions such as «what is the natural history of gastroesophageal reflux in the patient undergoing gastric sleeve surgery?», «how many patients after vertical gastrectomy will develop gastroesophageal reflux?» and «how many patients will worsen their previous reflux after this technique?» are intended to be addressed in the present article.
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Affiliation(s)
- Sonia Fernández-Ananín
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Carme Balagué Ponz
- Unidad de Cirugía Esofagogástrica, Bariátrica y Metabólica, Servicio de Cirugía General y Digestiva, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Laia Sala
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Antoni Molera
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eulalia Ballester
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Berta Gonzalo
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Noelia Pérez
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eduardo M Targarona
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Sethi I, Aicher A, Cheema F, Powers K, Rosenbluth A, Pryor A, Spaniolas K. Postoperative outcomes for sleeve gastrectomy patients with positive pH-defined GERD. Surg Endosc 2023; 37:6861-6866. [PMID: 37311887 DOI: 10.1007/s00464-023-10149-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/20/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a possible side effect of sleeve gastrectomy (SG). However, procedure selection for patients with GERD and risk factors for morbidity after bypass surgeries is complex. For patients with a preoperative GERD diagnosis, literature related to worsening postoperative symptoms is discordant. OBJECTIVE This study evaluated the effects of SG on patients with pre-operative GERD confirmed through pH testing. SETTING University Hospital, United States. METHODS This was a single-center case-series. SG patients with preoperative pH testing were compared based on DeMeester scoring. Preoperative demographics, endoscopy results, need for conversion surgery, and changes in gastrointestinal quality of life (GIQLI) scores were compared. Two-sample independent t-tests assuming unequal variances were used for statistical analysis. RESULTS Twenty SG patients had preoperative pH testing. Nine patients were GERD positive; median DeMeester score 26.7 (22.1-31.15). Eleven patients were GERD negative, with a median DeMeester score of 9.0 (4.5-13.1). The two groups had similar median BMI, preoperative endoscopic findings and use of GERD medications. Concurrent hiatal hernia repair was performed in 22% of GERD positive vs. 36% of GERD negative patients, (p = 0.512). Two patients in the GERD positive cohort required conversion to gastric bypass (22%), while none in the GERD negative cohort did. No significant postoperative differences were noted in GIQLI, heartburn, or regurgitation symptoms. CONCLUSION Objective pH testing may allow the differentiation of patients who would be higher risk for need for conversion to gastric bypass. For patients with mild symptoms, but negative pH testing, SG may represent a durable option.
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Affiliation(s)
- Ila Sethi
- Division of Bariatric, Foregut, and Advanced GI Surgery, Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11790, USA.
| | - Aidan Aicher
- Division of General Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Fareed Cheema
- Department of Surgery, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA
| | - Kinga Powers
- Division of Bariatric, Foregut, and Advanced GI Surgery, Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11790, USA
| | - Amy Rosenbluth
- Division of Bariatric, Foregut, and Advanced GI Surgery, Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11790, USA
| | - Aurora Pryor
- Department of Surgery, Long Island Jewish Medical Center, Queens, NY, USA
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut, and Advanced GI Surgery, Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11790, USA
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Ghanem OM, Ghazi R, Abdul Razzak F, Bazerbachi F, Ravi K, Khaitan L, Kothari SN, Abu Dayyeh BK. Turnkey algorithmic approach for the evaluation of gastroesophageal reflux disease after bariatric surgery. Gastroenterol Rep (Oxf) 2023; 11:goad028. [PMID: 37304555 PMCID: PMC10256627 DOI: 10.1093/gastro/goad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/12/2022] [Accepted: 02/01/2023] [Indexed: 06/13/2023] Open
Abstract
Bariatric surgeries are often complicated by de-novo gastroesophageal reflux disease (GERD) or worsening of pre-existing GERD. The growing rates of obesity and bariatric surgeries worldwide are paralleled by an increase in the number of patients requiring post-surgical GERD evaluation. However, there is currently no standardized approach for the assessment of GERD in these patients. In this review, we delineate the relationship between GERD and the most common bariatric surgeries: sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), with a focus on pathophysiology, objective assessment, and underlying anatomical and motility disturbances. We suggest a stepwise algorithm to help diagnose GERD after SG and RYGB, determine the underlying cause, and guide the management and treatment.
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Affiliation(s)
- Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rabih Ghazi
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, MN, USA
| | - Karthik Ravi
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Leena Khaitan
- Department of Surgery, Case Western Reserve University, Cleveland, OH, USA
| | | | - Barham K Abu Dayyeh
- Corresponding author. Division of Gastroenterology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel: +1-507-284-2511; Fax: +1-507-284-0538;
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6
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Indja B, Chan DL, Talbot ML. Hiatal reconstruction is safe and effective for control of reflux after laparoscopic sleeve gastrectomy. BMC Surg 2022; 22:347. [PMID: 36131312 PMCID: PMC9490990 DOI: 10.1186/s12893-022-01800-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Gastroesophageal reflux is a known complication following laparoscopic sleeve gastrectomy (LSG) as anatomical changes predispose to reduced lower esophageal sphincter pressure and development of hiatus hernia. The mainstay of surgical management has been Roux-en-Y gastric bypass (RYGB) which is not without risk. Hiatus hernia repair (HHR) with surgical reattachment of the oesophagus to the crura, recreating the phreno-esophageal ligament is a simple procedure specifically targeting a number of anatomical changes responsible for reflux in this population. Methods We conducted a single centre retrospective analysis of adult patients with post-sleeve reflux refractory to medical treatment, managed with either HHR, RYGB or One-anastomosis Duodenal switch (OADS). PPI use and symptoms of reflux were assessed at early and mid-term time points via validated questionnaires.
Results 99 patients were included, of these the surgical procedure was HHR alone in 58, RYGB in 29 and OADS in 12. At early follow-up control of reflux symptoms was achieved in 72.4% after HHR, 82.1% after RYGB and 100% after OADS with no significant difference between groups (p = 0.09). At mid-term followup (median 10 months IQR 7–21) there was no significant difference in the presence of symptomatic reflux as determined by post-op Visick score nor a difference in PPI use. The GerdQ score was significantly lower after OADS as compared to HHR and RYGB (4.6 ± 2.3 vs 7.7 ± 2.2 vs 8.7 ± 3.5, p = 0.006). Conclusion HHR with reconstruction of the phreno-esophageal ligament is a safe and effective procedure for patients with reflux after LSG, that avoids more complex operations such as RYGB and OADS and their associated long-term sequelae.
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Affiliation(s)
- Ben Indja
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. .,Department of Surgery, St George Hospital, Sydney, NSW, Australia. .,Upper GI Surgery, St George Private Hospital, Suite 3, Level 5, 1 South, Sydney, NSW, 2217, Australia.
| | - Daniel L Chan
- Department of Surgery, St George Hospital, Sydney, NSW, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Michael L Talbot
- Department of Surgery, St George Hospital, Sydney, NSW, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia.,Upper GI Surgery, St George Private Hospital, Suite 3, Level 5, 1 South, Sydney, NSW, 2217, Australia
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Li JZ, Broderick RC, Huang EY, Serra J, Wu S, Genz M, Sandler BJ, Jacobsen GR, Horgan S. Post Sleeve Reflux: indicators and impact on outcomes. Surg Endosc 2022; 37:3145-3153. [PMID: 35948805 DOI: 10.1007/s00464-022-09454-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Post-operative gastroesophageal reflux disease (GERD) remains a significant morbidity following sleeve gastrectomy (SG). We aim to evaluate the incidence and impact within a single center experience. MATERIALS AND METHODS A retrospective review of a prospectively maintained database was performed identifying laparoscopic or robotic SG patients. Primary outcomes included weight loss, rates of post-operative GERD (de-novo or aggravated), and re-intervention. Subgroup analysis was performed between patients with (Group 1) and without (Group 2) post-operative GERD. De-novo GERD and aggravated was defined as persistent GERD complaints or new/increased PPI usage in GERD naive or prior GERD patients, respectively. RESULTS 392 patients were identified between 2014 and 2019. Average demographics: age 42.3 (18-84) years, Charlson Comorbidity Index (CCI) 1.12 (0-10), and body mass index (BMI) 47.7 (28-100). 98% were performed laparoscopically. Average excess weight loss (EWL) was 51.0% and 46.4% at 1 and 2 years post-operatively. Average follow up was 516 (6-2694) days. 69 (17%) patients developed post operative de-novo or aggravated GERD. Group 1 had significantly higher EWL at 9 months (57% vs 47%, p 0.003). 13 (3%) patients required operative re-intervention for GERD and other morbidities: 4 RYGB conversions, 4 diagnostic laparoscopies, 3 HHR, 1 MSA placement. Group 1 had higher rates of post-operative intervention (14% vs 1%, p 0.0001). Subanalysis demonstrated that Group 1 had elevated preoperative DeMeester scores on pH testing (34.8 vs 18.9, p 0.03). De-novo GERD had an elevated post-operative total acid exposure when compared to aggravated GERD (12.7% vs 7.0% p 0.03). No significant differences were found between preoperative endoscopy findings, pre and postoperative total acid exposure, post-operative DeMeester scores, and high-resolution manometry values regarding de-novo/aggravated GERD development. CONCLUSION Preoperative DeMeester scores may serve as risk indicators regarding post-operative GERD. Outcomes such as reintervention remain elevated in post-operative GERD patients.
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Affiliation(s)
- Jonathan Z Li
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
| | - Ryan C Broderick
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Estella Y Huang
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Joaquin Serra
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Samantha Wu
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Michael Genz
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Bryan J Sandler
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Garth R Jacobsen
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Santiago Horgan
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
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Sancho Moya C, Bruna Esteban M, Sempere García-Argüelles J, Ferrer Barceló L, Monzó Gallego A, Mirabet Sáez B, Mulas Fernández C, Albors Bagá P, Vázquez Prado A, Oviedo Bravo M, Montalvá Orón E. The Impact of Sleeve Gastrectomy on Gastroesophageal Reflux Disease in Patients with Morbid Obesity. Obes Surg 2022; 32:615-624. [PMID: 35048247 DOI: 10.1007/s11695-021-05808-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The impact of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) has not been widely quantified, and the data in the literature remain controversial. MATERIALS AND METHODS Candidates for LSG underwent barium swallow, esophageal manometry, ambulatory 24-h esophageal pH monitoring (APM), and gastric emptying scintigraphy before and after surgery (1 and 18 months). Symptoms were evaluated using a gastroesophageal reflux disease questionnaire (GERDq). Esophagogastroduodenoscopy was performed preoperatively in all patients and at 18 months postoperatively in patients who had suffered from preoperative esophagitis. RESULTS Fifty-two patients were included in the study (64.4% women and 34.6% men) with a median age of 46 years (25-63 years) and BMI of 45.0 ± 5.6 kg/m2. The follow-up rates at 1 and 18 months were 82.7% and 80.8%. At 18 months, the percentage of weight loss (%TWL) was 33.6 ± 10.4% and the percentage of excess BMI loss (%EBMIL) was 77.6 ± 25%. Postoperatively, a significant increase in accelerated gastric emptying and impaired esophageal body motility occurred at 1 and 18 months. A significant worsening of all the values obtained at both 1 and 18 months postoperatively becomes evident when comparing the results of the APM. After surgery, 76.4% of patients had developed "de novo" GERD at 1 month and 41% at 18 months. No improvement was found in patients with symptomatic GERD. CONCLUSION Based on the results of this study, LSG led to a considerable rate of postoperative "de novo" GERD. In addition, no improvement was found in patients with symptomatic GERD.
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Affiliation(s)
| | - Marcos Bruna Esteban
- Department of Esophagogastric Surgery, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | | | - Luis Ferrer Barceló
- Department of Digestive, Consorcio Hospital General Universitario de Valencia (CHGUV), Valencia, Spain
| | - Ana Monzó Gallego
- Department of Digestive, Consorcio Hospital General Universitario de Valencia (CHGUV), Valencia, Spain
| | - Beatriz Mirabet Sáez
- Department of Digestive, Consorcio Hospital General Universitario de Valencia (CHGUV), Valencia, Spain
| | - Claudia Mulas Fernández
- Department of Esophagogastric and Obesity Surgery, Consorcio Hospital General Universitario de Valencia (CHGUV), Valencia, Spain
| | - Pilar Albors Bagá
- Department of Esophagogastric and Obesity Surgery, Consorcio Hospital General Universitario de Valencia (CHGUV), Valencia, Spain
| | - Antonio Vázquez Prado
- Department of Esophagogastric and Obesity Surgery, Consorcio Hospital General Universitario de Valencia (CHGUV), Valencia, Spain
| | - Miguel Oviedo Bravo
- Department of Esophagogastric and Obesity Surgery, Consorcio Hospital General Universitario de Valencia (CHGUV), Valencia, Spain
| | - Eva Montalvá Orón
- Department of Hepatobiliary, Pancreatic Surgery and Transplantation, Hospital Universitari I Politècnic La Fe, Valencia, Spain
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Abstract
Patients with obesity who present with gastroesophageal reflux disease (GERD) require a nuanced approach. Those with lower body mass index (BMI) (less than 33) can be counseled on weight loss, and if successful may be approached with laparoscopic fundoplication. Those who are unable to achieve weight loss or those who present with a BMI greater than or equal to 35 should proceed with laparoscopic Roux-en-Y gastric bypass (LRYGB). Conversion to LRYGB from sleeve gastrectomy is a safe and effective way to manage GERD after sleeve gastrectomy.
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10
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Sans A, Frey S, De Montrichard M, Takoudju C, Coron E, Blanchard C. Impact on sleeve gastrectomy in patients with esophageal motor disorder. Surg Obes Relat Dis 2021; 17:1890-1896. [PMID: 34412971 DOI: 10.1016/j.soard.2021.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/06/2021] [Accepted: 07/10/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) and esophageal motor disorders (EMD) are frequent conditions among patients with obesity. The effects of sleeve gastrectomy (SG) on esophageal function can worsen GERD, but little is known about its effects on EMD and the consequences of preexisting EMD on GERD after SG. OBJECTIVES To study the postoperative outcomes of SG in a population of patients displaying preexisting EMD. SETTING University Hospital, France. METHODS Patients with EMD confirmed by high-resolution manometry who underwent a laparoscopic SG between 2010 and 2019 were retrospectively included in this monocenter study. GERD symptoms and high-resolution manometry results were recorded before surgery and during follow-up. Conversion to gastric bypass were also recorded. RESULTS Thirty-seven patients were included. Mean age was 52.6 ± 12.9 years. Most patients were female (70%). EMD were achalasia (19% of patients), hypercontractile (22%), hypocontractile (30%) and nutcracker esophagus (22%), and ineffective esophageal motility (8%). GERD symptoms were present in 10 patients (27%) preoperatively and 18 (49%) postoperatively. Achalasia was not resolved after SG and was constantly associated with disabling food blockage or GERD symptoms after surgery, and 3 of 4 patients with nutcracker esophagus had postoperative GERD symptoms and underwent gastric bypass. CONCLUSIONS This study is the largest to describe the course of GERD and EMD after SG in patients displaying preoperative EMD. Achalasia and nutcracker esophagus are associated with poorer postoperative outcomes, and another procedure such as a gastric bypass should be performed.
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Affiliation(s)
- Arnaud Sans
- Chirurgie Cancérologique Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalo-universitaire de Nantes Hôtel-Dieu, Nantes, France
| | - Samuel Frey
- Chirurgie Cancérologique Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalo-universitaire de Nantes Hôtel-Dieu, Nantes, France; L'institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France
| | - Marie De Montrichard
- Chirurgie Cancérologique Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalo-universitaire de Nantes Hôtel-Dieu, Nantes, France
| | - Celine Takoudju
- Service d'hépatologie et gastroentérologie, Institut des Maladies de l'Appareil Digestif, Centre Hospitalo-Universitaire Hôtel-Dieu, Nantes, France
| | - Emmanuel Coron
- Service d'hépatologie et gastroentérologie, Institut des Maladies de l'Appareil Digestif, Centre Hospitalo-Universitaire Hôtel-Dieu, Nantes, France
| | - Claire Blanchard
- Chirurgie Cancérologique Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalo-universitaire de Nantes Hôtel-Dieu, Nantes, France; L'institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France.
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11
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Abstract
PURPOSE OF REVIEW Obesity is rapidly increasing in prevalence, and bariatric surgery has become a popular treatment option that can improve all-cause mortality in obese individuals. Gastroesophageal reflux disease (GERD) and esophageal motility disorders are common in the obese population, and the effects of bariatric surgery on these conditions differ depending on the type of bariatric surgery performed. RECENT FINDINGS Laparoscopic adjustable gastric banding has declined in popularity due to its contributions to worsening GERD symptoms and the development of esophageal dysmotility. Although laparoscopic sleeve gastrectomy (LSG) is the most popular type of bariatric surgery, a comprehensive assessment for acid reflux should be performed as LSG has been linked with worsening GERD. Novel methods to address GERD due to LSG include magnetic sphincter augmentation and concomitant fundoplication. Due to the decreased incidence of postoperative GERD and dysmotility compared to other types of bariatric surgeries, Roux-en-Y gastric bypass should be considered for obese patients with GERD and esophageal dysmotility. SUMMARY Bariatric surgery can affect esophageal motility and contribute to worsening or development of GERD. A thorough workup of gastrointestinal symptoms before bariatric surgery should be performed with consideration for formal testing with high-resolution manometry and pH testing. Based on these results, the choice of bariatric surgery technique should be tailored accordingly to improve clinical outcomes.
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12
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Balla A, Meoli F, Palmieri L, Corallino D, Sacchi MC, Ribichini E, Coletta D, Pronio A, Badiali D, Paganini AM. Manometric and pH-monitoring changes after laparoscopic sleeve gastrectomy: a systematic review. Langenbecks Arch Surg 2021; 406:2591-2609. [PMID: 33855600 PMCID: PMC8803809 DOI: 10.1007/s00423-021-02171-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/05/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE Aim of this systematic review is to assess the changes in esophageal motility and acid exposure of the esophagus through esophageal manometry and 24-hours pH-monitoring before and after laparoscopic sleeve gastrectomy (LSG). METHODS Articles in which all patients included underwent manometry and/or 24-hours pH-metry or both, before and after LSG, were included. The search was carried out in the PubMed, Embase, Cochrane, and Web of Science databases, revealing overall 13,769 articles. Of these, 9702 were eliminated because they have been found more than once between the searches. Of the remaining 4067 articles, further 4030 were excluded after screening the title and abstract because they did not meet the inclusion criteria. Thirty-seven articles were fully analyzed, and of these, 21 further articles were excluded, finally including 16 articles. RESULTS Fourteen and twelve studies reported manometric and pH-metric data from 402 and 547 patients, respectively. At manometry, a decrease of the lower esophageal sphincter resting pressure after surgery was observed in six articles. At 24-hours pH-metry, a worsening of the DeMeester score and/or of the acid exposure time was observed in nine articles and the de novo gastroesophageal reflux disease (GERD) rate that ranged between 17.8 and 69%. A meta-analysis was not performed due to the heterogeneity of data. CONCLUSIONS After LSG a worsening of GERD evaluated by instrumental exams was observed such as high prevalence of de novo GERD. However, to understand the clinical impact of LSG and the burden of GERD over time further long-term studies are necessary.
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Affiliation(s)
- Andrea Balla
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Francesca Meoli
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Livia Palmieri
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Diletta Corallino
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Maria Carlotta Sacchi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Emanuela Ribichini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Diego Coletta
- Department of General Surgery, Emergency Department, Emergency and Trauma Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Annamaria Pronio
- Digestive Endoscopy Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Danilo Badiali
- Department of Translational and Precision Medicine, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Alessandro M Paganini
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
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13
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Gorodner V, Matucci A, Solé L, Figueredo R, Sánchez C, Caro L, Grigaites A. Does Roux-en-Y Gastric Bypass Really Cure Gastroesophageal Reflux Disease? Analysis of Objective Data. J Laparoendosc Adv Surg Tech A 2021; 32:103-110. [PMID: 33844944 DOI: 10.1089/lap.2020.0999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the treatment of choice for obesity with gastroesophageal reflux disease (GERD). There are few reports showing objective data based on esophageal function tests (EFTs). The aim of our study was to evaluate the influence of LRYGB on GERD. Methods: Candidates for laparoscopic sleeve gastrectomy (LSG) underwent preoperative esophageal manometry (EM) and 24-hour pH monitoring. Based on the negative influence of LSG on GERD, patients with abnormal pH were offered LRYGB. Those patients repeated EFTs, esophagogastroduodenoscopy, and symptom questionnaire 1 year after surgery. Results: Two hundred fifty LSG candidates underwent preoperative EFTs; 38% were redirected to LRYGB due to abnormal pH and 13 (18%) completed EFTs postoperatively. In ten women, age: 40 ± 7 years, body mass index: 41 ± 1 kg/m2. EM: lower esophageal sphincter (LES) length increased from 2.6 to 2.9 cm (P = not statistically significant [NS]), and LES pressure decreased from 15 to 14.2 mmHg (P = NS). Preoperatively, LES was normotensive in 12 (92%) patients and postoperatively in 11 (85%) (P = NS). DeMeester score decreased from 35.7 to 11 (P < .001). Postoperatively, 9 (69%) patients resolved their GERD, 3 (23%) improved, and 1 (8%) remained the same (P < .001). Symptoms decreased significantly after surgery. Two patients (15%) had Grade A esophagitis. One of them was able to resolve it, while the other 1 remained the same. Conclusions: Our preliminary data showed that after LRYGB, LES pressure remained the same and DeMeester score decreased, while 69% of patients resolved their GERD. Therefore, LRYGB seems to be an excellent option for obesity and GERD.
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Affiliation(s)
| | | | - Laura Solé
- GEDYT (Gastroenterología Diagnóstica y Terapéutica), Buenos Aires, Argentina
| | - Ricardo Figueredo
- GEDYT (Gastroenterología Diagnóstica y Terapéutica), Buenos Aires, Argentina
| | - Christian Sánchez
- GEDYT (Gastroenterología Diagnóstica y Terapéutica), Buenos Aires, Argentina
| | - Luis Caro
- GEDYT (Gastroenterología Diagnóstica y Terapéutica), Buenos Aires, Argentina
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Guzman-Pruneda FA, Brethauer SA. Gastroesophageal Reflux After Sleeve Gastrectomy. J Gastrointest Surg 2021; 25:542-550. [PMID: 32935271 DOI: 10.1007/s11605-020-04786-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/03/2020] [Indexed: 01/31/2023]
Abstract
Sleeve gastrectomy continues to be the most commonly performed bariatric operation worldwide. Development or worsening of pre-existing GERD has been recognized as a significant issue postoperatively. There is a paucity of information concerning the most appropriate preoperative workup and the technical and anatomical factors that may or may not contribute to the occurrence of reflux symptoms. Contemporary data quality is deficient given the predominantly retrospective nature, limited follow-up time, and heterogeneous outcome measures across studies. This has produced mixed results regarding the postoperative incidence and severity of GERD. Ultimately, better-constructed investigations are needed in order to offer evidence-based recommendations that may guide preoperative workup and improved patient selection criteria.
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Affiliation(s)
- Francisco A Guzman-Pruneda
- Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stacy A Brethauer
- Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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15
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Li S, Jiao S, Zhang S, Zhou J. Revisional Surgeries of Laparoscopic Sleeve Gastrectomy. Diabetes Metab Syndr Obes 2021; 14:575-588. [PMID: 33603423 PMCID: PMC7882429 DOI: 10.2147/dmso.s295162] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/08/2021] [Indexed: 12/11/2022] Open
Abstract
Bariatric surgery has become increasingly common due to the worldwide obesity epidemic. A shift from open to laparoscopic surgery, specifically, laparoscopic sleeve gastrectomy (LSG), has occurred in the last two decades because of the low morbidity and mortality rates of LSG. Although LSG is a promising treatment option for patients with morbid obesity due to restrictive and endocrine mechanisms, it requires modifications for a subset of patients because of weight regain and tough complications, such as gastroesophageal reflux, strictures, gastric leak, and persistent metabolic syndrome., Revision surgeries have become more and more indispensable in bariatric surgery, accounting for 7.4% in 2016. Mainstream revisional bariatric surgeries after LSG include Roux-en-Y gastric bypass, repeated sleeve gastrectomy, biliopancreatic diversion, duodenal switch, duodenal-jejunal bypass, one-anastomosis gastric bypass, single anastomosis duodeno-ileal bypass (SAID) and transit bipartition. This review mainly describes the revisional surgeries of LSG, including the indication, choice of surgical method, and subsequent effect.
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Affiliation(s)
- Siyuan Li
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Siqi Jiao
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Siwei Zhang
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Jiangjiao Zhou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
- Correspondence: Jiangjiao Zhou Department of General Surgery, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, Hunan, 410011, People’s Republic of China Email
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16
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Beware Pathological Findings of the Stomach in Patients Undergoing Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2020; 31:337-342. [PMID: 33047288 DOI: 10.1007/s11695-020-05029-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022]
Abstract
Abnormal anatomic findings are a major concern before performing bariatric surgery, while pathological changes are considered less often. The present study aimed to investigate the incidences of gastric lesions warranting follow-up in patients undergoing bariatric surgery. Meta-analyses were conducted to calculate the pooled incidences of gastric lesions in patients undergoing bariatric surgery. Fifty-nine studies including 32,789 patients were included: 26 on endoscopic biopsy, 26 on pathological findings of the excised specimen, five on the intraoperative exploration results, and two on both preoperative endoscopy and postoperative specimen. Generally, atrophic gastritis (3.05% (95% CI (confidence interval) 1.53-6.09)), intestinal metaplasia (2.44% (95% CI 1.76-3.25)), and GIST (gastrointestinal stromal tumor) (0.45% (95% CI 0.31-0.60)) were not rarely found. Routine preoperative endoscopy was applied in 16 studies, and the pooled incidences of atrophic gastritis and intestinal metaplasia were 2.64% (95% CI 0.78-8.9) and 2.70% (95% CI 0.9-5.42), respectively. Hp. (Helicobacter pylori) screening and eradication were routinely performed in 10 studies, and that was related to a reduced incidence of atrophic gastritis (0.94% (95% CI 0.03-2.92)) vs. 4.31% (95% CI 2.01-9.23). GIST was more likely to be found by intraoperative exploration than by preoperative endoscopy (0.68% (95% CI 0.50-0.93) vs. 0.23% (95% CI 0.11-0.52)). Patients undergoing bariatric surgery demonstrated non-negligible incidences of gastric pathologies warranting follow-up. Preoperative endoscopy and careful intraoperative exploration should be routinely performed, and Hp. screening and eradication are suggested before endoscopy. In condition that such findings are detected, sleeve gastrectomy may be preferred over Roux-en-Y gastric bypass.
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17
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Jaruvongvanich V, Matar R, Ravi K, Murad MH, Vantanasiri K, Wongjarupong N, Ungprasert P, Vargas EJ, Maselli DB, Prokop LJ, Abu Dayyeh BK. Esophageal Pathophysiologic Changes and Adenocarcinoma After Bariatric Surgery: A Systematic Review and Meta-Analysis. Clin Transl Gastroenterol 2020; 11:e00225. [PMID: 32955206 PMCID: PMC7447443 DOI: 10.14309/ctg.0000000000000225] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION To assess the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on acid reflux and esophageal motor function and to evaluate the observation of esophageal adenocarcinoma (EAC) after bariatric surgery. METHODS We searched 5 databases for adults who underwent SG or RYGB and had esophageal pH test and/or esophageal manometry before and after surgery. A separate systemic search of observational studies and a retrospective review at 3 institutions of adults who developed EAC after these surgeries were conducted. Outcomes were changes in manometric and pH parameters and EAC cases after SG and RYGB. RESULTS A total of 27 nonrandomized studies (SG: 612 patients; RYGB: 470 patients) were included. After SG, lower esophageal sphincter pressure and esophageal body amplitude were decreased and the risk of ineffective esophageal motility was increased. Total and recumbent acid exposure times were increased. After RYGB, an increased risk of ineffective esophageal motility was observed. Total, upright, and recumbent acid exposure times were decreased. The total reflux episodes remained unchanged but with increased nonacid reflux and decreased acid reflux events. Including our largest series, 31 EAC cases have been reported to date after SG and RYGB. DISCUSSION This systematic review demonstrates increased acid reflux after SG and decreased acid reflux after RYGB. An observed increased nonacid reflux after RYGB might contribute to failure of gastroesophageal reflux disease improvement. This refluxate might be noxious to the esophagus, warranting further studies. RYGB might not entirely preserve esophageal function as previously believed.
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Affiliation(s)
| | - Reem Matar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Karthik Ravi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - M. Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Kornpong Vantanasiri
- Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Nicha Wongjarupong
- Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Patompong Ungprasert
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA;
| | - Eric J. Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B. Maselli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry J. Prokop
- Division of Library Services, Mayo Clinic, Rochester, Minnesota, USA
| | - Barham K. Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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18
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Lallemand L, Duchalais E, Musquer N, Jacobi D, Coron E, des Varannes SB, Mirallié E, Blanchard C. Does Sleeve Gastrectomy Increase the Risk of Barret's Esophagus? Obes Surg 2020; 31:101-110. [PMID: 32725593 DOI: 10.1007/s11695-020-04875-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Sleeve gastrectomy (SG) is the most commonly performed bariatric surgical procedure worldwide. However, the impact of SG on Barrett's esophagus (BE) remains unknown. The main objective was to determine the rate of BE 5 years after SG. MATERIALS AND METHODS Patients, operated in 2012 by SG in one center, who preoperatively and postoperatively (5 years) underwent upper gastrointestinal endoscopy (UGIE), 24-h pH monitoring, and esophageal manometry, were included. RESULTS A total of 59 (81.4% of females) patients were included. Preoperative mean age and body mass index were 45.2 ± 11.7 years and 45.2 ± 8.1 kg/m2 respectively. Preoperative 24-h pH monitoring reported gastroesophageal reflux disease (GERD) in 18 (30.5%) patients. The mean total body weight loss at 5 years was 16.1 ± 11.2%. No significant difference was observed between preoperative and postoperative de Meester's score (20.2 ± 27.1 and 21.0 ± 21.5 respectively (p = 0.91)) nor between preoperative and postoperative number of acid reflux episodes per 24 h (65.1 ± < 40.0 and 50.3 ± 40.3 (p = 0.21)). The UGIE revealed 5 patients (8.5%) with endoscopically suspected esophageal metaplasia, without confirmed metaplasia on histologic examination. GERD was diagnosed in 32 patients (54.2%), de novo GERD in 16 (27.1%) patients and esophagitis in 16 (27.1%) patients. At 5 years, 25 patients (42.4%) reported a lack of regular medical follow-up. CONCLUSIONS This study highlights the incidence of postoperative GERD and endoscopic lesions following SG. Even though SG is not contraindicated in case of reflux, GERD patients who undergo SG may be supervised by a close endoscopic surveillance.
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Affiliation(s)
- L Lallemand
- Chirurgie Cancérologique, Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalo-universitaire de Nantes (CHU) Hôtel-Dieu, Place Alexis Ricordeau, 44093, Nantes, France
| | - E Duchalais
- Chirurgie Cancérologique, Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalo-universitaire de Nantes (CHU) Hôtel-Dieu, Place Alexis Ricordeau, 44093, Nantes, France
- Université de Nantes, quai de Tourville, 44000, Nantes, France
| | - N Musquer
- Service d'Hépato-Gastroentérologie et Assistance Nutritionnelle, Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalo-Universitaire (CHU), Nantes, France
| | - D Jacobi
- Université de Nantes, quai de Tourville, 44000, Nantes, France
- L'Institut du Thorax, Service d'Endocrinologie, Maladies Métaboliques et Nutrition, CHU Nantes, Nantes, France
- L'Institut du Thorax, Inserm UMR-S1087, CNRS, UNIV Nantes, Nantes, France
| | - E Coron
- Université de Nantes, quai de Tourville, 44000, Nantes, France
- Service d'Hépato-Gastroentérologie et Assistance Nutritionnelle, Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalo-Universitaire (CHU), Nantes, France
| | - S Bruley des Varannes
- Université de Nantes, quai de Tourville, 44000, Nantes, France
- Service d'Hépato-Gastroentérologie et Assistance Nutritionnelle, Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalo-Universitaire (CHU), Nantes, France
| | - E Mirallié
- Chirurgie Cancérologique, Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalo-universitaire de Nantes (CHU) Hôtel-Dieu, Place Alexis Ricordeau, 44093, Nantes, France
- Université de Nantes, quai de Tourville, 44000, Nantes, France
| | - C Blanchard
- Chirurgie Cancérologique, Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalo-universitaire de Nantes (CHU) Hôtel-Dieu, Place Alexis Ricordeau, 44093, Nantes, France.
- Université de Nantes, quai de Tourville, 44000, Nantes, France.
- L'Institut du Thorax, Service d'Endocrinologie, Maladies Métaboliques et Nutrition, CHU Nantes, Nantes, France.
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De Montrichard M, Greilsamer T, Jacobi D, Bruley des Varannes S, Mirallié E, Blanchard C. Predictive value of preoperative DeMeester score on conversion to Roux-en-Y gastric bypass for gastroeosophageal reflux disease after sleeve gastrectomy. Surg Obes Relat Dis 2020; 16:1219-1224. [PMID: 32456850 DOI: 10.1016/j.soard.2020.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obesity is well known to increase the risk of gastroesophageal reflux disease (GERD). The impact of sleeve gastrectomy (SG) on GERD is still discussed but seems to be associated with the development of de novo GERD or the exacerbation of preexisting GERD. OBJECTIVE The objective of this study was to evaluate the impact of preoperative pH monitoring, using the DeMeester score (DMS), on the risk of conversion to Roux-en-Y gastric bypass (RYGB) after SG. SETTING University Hospital in Nantes, France. METHODS This monocentric study reported the results of a retrospective chart review of 523 obese individuals treated between 2011 and 2018. All patients underwent primary bariatric surgery; 95% had undergone an SG. GERD diagnosis was established with preoperative DMS based on 24-hour esophageal pH monitoring. RESULTS Preoperative DMS was identified in 423 patients (86%). Sixty-seven patients (14%) underwent a second bariatric procedure; among them, 36 (54%) have been converted to RYGB because of GERD. There was no significant difference between preoperative DMS (16.1 ± 22 versus 13.7 ± 14, P = .37) in patients undergoing conversion for GERD and the nonconverted ones. The sensitivity, specificity, positive predictive, and negative predictive values of the preoperative DMS for predicting conversion to RYGB were 25%, 66%, 7%, and 4%, respectively. In patients who underwent a conversion for GERD, DMS (P < .002), rates of esophagitis (P = .035), and hiatal hernia (P = .039) significantly increased after SG. CONCLUSION Preoperative DMS alone is not predictive of the risk of conversion of SG to RYGB for GERD.
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Affiliation(s)
- Marie De Montrichard
- Clinique de Chirurgie Cancérologique Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalo-universitaire de Nantes (CHU) Hôtel-Dieu, Nantes, France
| | - Tristan Greilsamer
- Clinique de Chirurgie Cancérologique Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalo-universitaire de Nantes (CHU) Hôtel-Dieu, Nantes, France
| | - David Jacobi
- L'institut du thorax, Department of Endocrinology, CHU Nantes, Nantes, France; L'institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France
| | - Stanislas Bruley des Varannes
- Service d'hépatologie et gastroentérologie, Institut des Maladies de l'Appareil Digestif, CHU Hôtel-Dieu, Nantes, France
| | - Eric Mirallié
- Clinique de Chirurgie Cancérologique Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalo-universitaire de Nantes (CHU) Hôtel-Dieu, Nantes, France
| | - Claire Blanchard
- Clinique de Chirurgie Cancérologique Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalo-universitaire de Nantes (CHU) Hôtel-Dieu, Nantes, France; L'institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France.
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Suter M. Gastroesophageal Reflux Disease, Obesity, and Roux-en-Y Gastric Bypass: Complex Relationship—a Narrative Review. Obes Surg 2020; 30:3178-3187. [DOI: 10.1007/s11695-020-04690-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Lopez-Nava G, Asokkumar R, Lacruz T, Rull A, Beltran L, Bautista-Castaño I. The effect of weight loss and exercise on Health-Related Quality of Life (HRQOL) following Endoscopic Bariatric Therapies (EBT) for obesity. Health Qual Life Outcomes 2020; 18:130. [PMID: 32384934 PMCID: PMC7206800 DOI: 10.1186/s12955-020-01359-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 04/08/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Endoscopic bariatric therapies (EBT) have demonstrated to induce weight loss and improve comorbidities in obese patients. However, little is known about its impact on health-related quality of life (HRQOL) outcomes and physical activity status. This study aimed to evaluate the change in HRQOL and physical activity following EBT induced weight loss in obese patients. Methods We approached 181 patients who underwent EBT in a standardized multidisciplinary follow-up program to participate in the study. We provided them two questionnaires-a) Short Form-36 health survey with the physical (PSC) and mental (MSC) summary component scores to capture generic HRQOL, and b) international physical activity questionnaire (IPAQ) for physical activity (PA). We administered the survey at baseline and at 9 months post-procedure. We expressed the procedure outcome as percentage total body weight loss (%TBWL). We expressed continuous variables as mean (SD) or median and categorical variables as percentages. We used non-parametric tests for comparison and performed multivariable linear regression analysis to identify factors associated with improvement in HRQOL. Results The mean age was 42.2 (11.3) years, and the mean BMI was 38 (5.9)kg/m2. A majority of them were female (n-132, 73%). The EBT included intragastric balloons (n-136, 75%) and endoscopic sleeve gastroplasty (n-24, 25%). The mean %TBWL achieved after the intervention was 16.9 (9.7)%. We noticed a significant improvement in the median PSC (77.8 vs. 90.4, p < 0.001) and MSC (67 vs. 80.2, p < 0.001) scores after EBT. Similarly, we observed a significant positive change in physical activity compared to baseline (1606.2 vs. 2749 MET-minutes/week, p = < 0.001). Linear regression analysis showed an increase in %TBWL was associated with significant improvement in PSC (β = 0.193, p = 0.003) and MSC (β = 0.166, p = 0.02) scores of HRQOL, and likewise, increase in PA was independently associated with improvement in MSC (β = 0.192, p = 0.01). We did not find any difference in outcome based on gender or the type of intervention. Conclusion EBT improves HRQOL in obese patients regardless of the type of intervention. The weight loss induced by EBT and the improvement in PA positively influence the health outcomes and quality of life.
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Affiliation(s)
- Gontrand Lopez-Nava
- Bariatric Endoscopy Unit, HM Sanchinarro Hospital, Calle de Oña, 10, 28050, Madrid, Spain.
| | - Ravishankar Asokkumar
- Bariatric Endoscopy Unit, HM Sanchinarro Hospital, Calle de Oña, 10, 28050, Madrid, Spain.,Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - T Lacruz
- Bariatric Endoscopy Unit, HM Sanchinarro Hospital, Calle de Oña, 10, 28050, Madrid, Spain
| | - A Rull
- Bariatric Endoscopy Unit, HM Sanchinarro Hospital, Calle de Oña, 10, 28050, Madrid, Spain
| | - L Beltran
- Bariatric Endoscopy Unit, HM Sanchinarro Hospital, Calle de Oña, 10, 28050, Madrid, Spain
| | - Inmaculada Bautista-Castaño
- Bariatric Endoscopy Unit, HM Sanchinarro Hospital, Calle de Oña, 10, 28050, Madrid, Spain.,Ciber of Obesity and Nutrition Pathophysiology (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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22
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Rausa E, Kelly ME, Galfrascoli E, Aiolfi A, Cavalcoli F, Turati L, Bonavina L, Sgroi G. Quality of Life and Gastrointestinal Symptoms Following Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy: a Systematic Review. Obes Surg 2020; 29:1397-1402. [PMID: 30693417 DOI: 10.1007/s11695-019-03737-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most common bariatric operations performed worldwide. Quality of life (QoL) is a crucial outcome metric. An electronic systematic search using PubMed, EMBASE, and Web of Science of studies comparing QoL after LSG and LRYGB was performed. QoL after both LSG and LRYGB considerably improves regardless the type of surgery. The QoL has a slight downward trend from the second to the fifth year postoperatively, but it remains higher than the baseline. LSG patients are more likely to suffer from gastroesophageal symptoms (GES). GES represent the only significant difference between the two procedures. A routine screening with gastroscopy and 24 h pH metry to help tailor the most appropriate surgical approach is advised.
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Affiliation(s)
- Emanuele Rausa
- Surgical Oncology Unit, Treviglio Hospital, Piazzale Ospedale 1, 24047, Treviglio, Bergamo, Italy.
| | - Michael E Kelly
- Department of Colorectal Surgery, Connolly Hospital, Dublin, Ireland
| | - Elisa Galfrascoli
- Division of General Surgery, Fatebenefratelli Hospital, Milan, Italy
| | - Albero Aiolfi
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy
| | - Federica Cavalcoli
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luca Turati
- Surgical Oncology Unit, Treviglio Hospital, Piazzale Ospedale 1, 24047, Treviglio, Bergamo, Italy
| | - Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy
| | - Giovanni Sgroi
- Surgical Oncology Unit, Treviglio Hospital, Piazzale Ospedale 1, 24047, Treviglio, Bergamo, Italy
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Comment on: Prevalence and impact of acid-related symptoms and diarrhea in patients undergoing Roux-en-Y gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis 2020; 16:527-528. [PMID: 32057677 DOI: 10.1016/j.soard.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 11/20/2022]
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Greilsamer T, de Montrichard M, Bruley des Varannes S, Jacobi D, Guillouche M, Regenet N, Mirallié E, Blanchard C. Hypotonic Low Esophageal Sphincter Is Not Predictive of Gastroesophageal Reflux Disease After Sleeve Gastrectomy. Obes Surg 2020; 30:1468-1472. [DOI: 10.1007/s11695-019-04335-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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25
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Clinical, Endoscopic, and Histologic Findings at the Distal Esophagus and Stomach Before and Late (10.5 Years) After Laparoscopic Sleeve Gastrectomy: Results of a Prospective Study with 93% Follow-Up. Obes Surg 2019; 29:3809-3817. [DOI: 10.1007/s11695-019-04054-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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26
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Braghetto I, Korn O. Late esophagogastric anatomic and functional changes after sleeve gastrectomy and its clinical consequences with regards to gastroesophageal reflux disease. Dis Esophagus 2019; 32:5487969. [PMID: 31076757 DOI: 10.1093/dote/doz020] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Gastroesophageal reflux disease (GERD) is described as a complication after sleeve gastrectomy. Most studies have used only clinical symptoms or upper gastrointestinal endoscopy for evaluation of reflux after surgery. Manometry, acid reflux tests, and esophageal barium swallow have not been commonly used. The objective of this study is to evaluate the short- and long-term incidence of clinical gastroesophageal reflux, the lower esophageal sphincter (LES) pressure, acid reflux, and endoscopic and radiological changes after sleeve gastrectomy (SG). A total of 315 patients were studied after SG; 248 (78.3%) completed more than 5 years of follow-up and 67 (21.4%) have more than 8 years (range 8-10 years) of follow-up. The preoperative weight was 106 + 14.1 kg with a mean body mass index 38.4 + 3.4 kg/m2. Patients with prior GERD were excluded for SG. During the follow-up patients were subjected to clinical, endoscopic, radiological, manometric, and 24-hour pH monitoring and duodenogastric reflux evaluations. Reflux symptoms were observed in 65.1% of patients at late follow-up. Patients without reflux symptoms presented an LES resting pressure of 13.3 ± 4.2 mmHg while patients with reflux symptoms presented an LES resting pressure of 9.8 + 2.1 mmHg. In patients with reflux symptoms, a positive acid reflux test was observed in 77.5% of patients with a mean DeMeester score of 41.7 ± 2.9 (range 14.1-131.7). During endoscopy, esophagitis was found in 29.4%, hiatal hernia in 5.7%, and Barrett's esophagus was diagnosed in 4.8%. Positive duodenogastric reflux was found in 31.8% of patients and 57.7% of our patients received proton pump inhibitor treatment after SG. Sleeve gastrectomy presents anatomic and functional changes that are associated with increased GERD.
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Affiliation(s)
- Italo Braghetto
- Department of Surgery, Hospital 'Dr. José J. Aguirre', Faculty of Medicine, University of Chile
| | - Owen Korn
- Department of Surgery, Hospital 'Dr. José J. Aguirre', Faculty of Medicine, University of Chile
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Valezi AC, Herbella FA, Mali-Junior J, Menezes MDA, Liberatti M, Sato RO. PREOPERATIVE MANOMETRY FOR THE SELECTION OF OBESE PEOPLE CANDIDATE TO SLEEVE GASTRECTOMY. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2018; 30:222-224. [PMID: 29019566 PMCID: PMC5630218 DOI: 10.1590/0102-6720201700030013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/20/2017] [Indexed: 12/12/2022]
Abstract
Background: Sleeve gastrectomy may alter esophageal motility and lower esophageal sphincter pressure. Aim: To detect manometric changings in the esophagus and lower esophageal sphincter before and after sleeve gastrectomy in order to select patients who could develop postoperative esophageal motilitity disorders and lower esophageal sphincter pressure modifications. Methods: Seventy-three patients were selected. All were submitted to manometry before the operation and one year after. The variables analyzed were: resting pressure of the lower esophageal sphincter, contraction wave amplitude, duration of contraction waves, and esophageal peristalsis. Data were compared before and after surgery and to the healthy and non-obese control group. Exclusion criteria were: previous gastric surgery, reflux symptoms or endoscopic findings of reflux or hiatal hernia, diabetes and use of medications that could affect esophageal or lower esophageal sphincter motility. Results: 49% of the patients presented preoperative manometric alterations: lower esophageal sphincter hypertonia in 47%, lower esophageal sphincter hypotonia in 22% and increase in contraction wave amplitude in 31%. One year after surgery, manometry was altered in 85% of patients: lower esophageal sphincter hypertonia in 11%, lower esophageal sphincter hypotonia in 52%, increase in contraction wave amplitude in 27% and 10% with alteration in esophageal peristalsis. Comparing the results between the preoperative and postoperative periods, was found statistical significance for the variables of the lower esophageal sphincter, amplitude of contraction waves and peristalsis. Conclusion: Manometry in the preoperative period of sleeve gastrectomy is not an exam to select candidates to this technique.
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Affiliation(s)
- Antonio Carlos Valezi
- Digestive System Surgery, Department of Surgery, State University of Londrina, Londrina, PR, Brazil
| | | | - Jorge Mali-Junior
- Digestive System Surgery, Department of Surgery, State University of Londrina, Londrina, PR, Brazil
| | | | - Mário Liberatti
- Digestive System Surgery, Department of Surgery, State University of Londrina, Londrina, PR, Brazil
| | - Rafael Onuki Sato
- Digestive System Surgery, Department of Surgery, State University of Londrina, Londrina, PR, Brazil
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Robertson AGN, Cameron AJ, Joyce B, Le Page P, Tulloh B, de Beaux AC, Lamb PJ. A prospective study of gastro-oesophageal reflux disease symptoms and quality of life 1-year post-laparoscopic sleeve gastrectomy. J Minim Access Surg 2018; 15:229-233. [PMID: 29974879 PMCID: PMC6561061 DOI: 10.4103/jmas.jmas_43_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction There are concerns that laparoscopic sleeve gastrectomy (LSG) can cause severe gastro-oesophageal reflux disease (GORD). The aim of this study was to assess GORD symptoms and quality of life following LSG. Methods A prospective study of patients undergoing LSG (2014-2016) was performed with follow-up by DeMeester Reflux/Regurgitation Score, Bariatric Quality of Life Index (BQLI) and Bariatric Analysis and Reporting Outcome System (BAROS) Score pre-operatively, 6 months and 1-year post-operatively. Results Twenty-two patients were studied. Mean modified DeMeester Reflux/Regurgitation Score improved from 2.25 (±0.67) pre-operatively to 0.81 (±0.25) at 12 months (P = 0.04). At 12 months, two patients had symptomatic reflux, but overall satisfaction score was unaffected. Mean BQLI Score underwent a non-significant improvement at 12 months. BAROS Score showed all patients to have excellent (n = 19) or very good (n = 3) results (12 months). Conclusion GORD symptoms improve for most patients' 1-year post-operatively. A small proportion of patients will develop troublesome GORD, but overall satisfaction remains high.
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Affiliation(s)
| | - Andrew J Cameron
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Brian Joyce
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Phil Le Page
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Bruce Tulloh
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew C de Beaux
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Peter J Lamb
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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Brunaud L, Nomine-Criqui C, Fouquet T, Sirveaux MA, Reibel N, Quilliot D. [Bariatric surgical procedures]. Presse Med 2018; 47:447-452. [PMID: 29731403 DOI: 10.1016/j.lpm.2018.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Obesity physioptahology is complex and involves several factors (genetic, behavioral, psychological…). In this still undefined context, bariatric surgery modifies gastrointestinal tract anatomy, reduces the caloric intake and modifies gastrointestinal hormonal secretions for some of them. Aim of this work was to describe bariatric surgical procedures (sleeve, gastric band, short-gastric gastric, biliopancreatic diversion), specifying their historical context and considering possible evolutions.
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Affiliation(s)
- Laurent Brunaud
- Université de Lorraine, CHU Nancy-Brabois, unité multidisciplinaire de la chirurgie de l'obésité du CHU de Nancy, 11, allée du Morvan, 54500 Vandoeuvre-les-Nancy, France; Université de Lorraine, unité Inserm U954, faculté de médecine, 9, avenue de la Forêt-de-Haye, 54500 Vandoeuvre-les-Nancy, France.
| | - Claire Nomine-Criqui
- Université de Lorraine, CHU Nancy-Brabois, unité multidisciplinaire de la chirurgie de l'obésité du CHU de Nancy, 11, allée du Morvan, 54500 Vandoeuvre-les-Nancy, France
| | - Thibaut Fouquet
- Université de Lorraine, CHU Nancy-Brabois, unité multidisciplinaire de la chirurgie de l'obésité du CHU de Nancy, 11, allée du Morvan, 54500 Vandoeuvre-les-Nancy, France
| | - Marie-Aude Sirveaux
- Université de Lorraine, CHU Nancy-Brabois, unité multidisciplinaire de la chirurgie de l'obésité du CHU de Nancy, 11, allée du Morvan, 54500 Vandoeuvre-les-Nancy, France
| | - Nicolas Reibel
- Université de Lorraine, CHU Nancy-Brabois, unité multidisciplinaire de la chirurgie de l'obésité du CHU de Nancy, 11, allée du Morvan, 54500 Vandoeuvre-les-Nancy, France
| | - Didier Quilliot
- Université de Lorraine, CHU Nancy-Brabois, unité multidisciplinaire de la chirurgie de l'obésité du CHU de Nancy, 11, allée du Morvan, 54500 Vandoeuvre-les-Nancy, France; Université de Lorraine, unité Inserm U954, faculté de médecine, 9, avenue de la Forêt-de-Haye, 54500 Vandoeuvre-les-Nancy, France
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30
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Quality of Life 1 Year After Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Roux-en-Y Gastric Bypass: a Randomized Controlled Trial Focusing on Gastroesophageal Reflux Disease. Obes Surg 2018; 27:2557-2565. [PMID: 28474319 DOI: 10.1007/s11695-017-2688-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Bariatric surgery is the only treatment option that achieves sustained weight loss in obese patients and that also has positive effects on obesity-related comorbidities. Laparoscopic sleeve gastrectomy (LSG) seems to achieve equal weight loss as laparoscopic Roux-en-Y gastric bypass (LRYGB), but there is still much debate about the quality of life (QOL) after LSG, mainly concerning the association with gastroesophageal reflux. Our hypothesis is that QOL after LSG is comparable with QOL after LRYGB. MATERIALS AND METHODS Between February 2013 and February 2014, 150 patients were randomized to undergo either LSG or LRYGB in our clinic. Differences in QOL were compared between groups by using multiple QOL questionnaires at follow-up moments preoperatively and 2 and 12 months after surgery. RESULTS After 12 months of follow-up, 128 patients had returned the questionnaires. Most QOL questionnaires showed significant improvement in scores between the preoperative moment and after 12 months of follow-up. The Gastroesophageal Reflux Disease Questionnaire (GerdQ) score deteriorated in the LSG group after 2 months, but recovered again after 12 months. After 2 months of follow-up, the mean GerdQ score was 6.95 ± 2.14 in the LSG group versus 5.50 ± 1.49 in the LRYGB group (p < 0.001). After 1 year, the mean GerdQ score was 6.63 ± 2.26 in the LSG group and 5.60 ± 1.07 in the LRYGB group (p = 0.001). CONCLUSION This randomized controlled trial shows that patients who underwent LSG have significantly higher GerdQ scores at both 2 and 12 months postoperatively than patients who underwent LRYGB, whereas overall QOL did not differ significantly.
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Thereaux J. [Relevance of bariatric surgery care]. Presse Med 2017; 47:444-446. [PMID: 29275026 DOI: 10.1016/j.lpm.2017.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/06/2017] [Accepted: 10/24/2017] [Indexed: 12/13/2022] Open
Abstract
The relevance of care in bariatric surgery must be judged in terms of the resulting benefit/risk balance. Laparoscopic approach has been proved to reduce postoperative mortality. Postoperative mortality is less than 0.1% in France. Depending on procedures, long-term percentage of weight loss is estimated around 15-30%. Long-term mortality and cardiovascular events are reduced compared to control patients. The over-risk of suicide should be known. Long-term follow-up after bariatric surgery is poor in France.
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Affiliation(s)
- Jérémie Thereaux
- Centre hospitalier universitaire de Brest, service de chirurgie viscérale et digestive, site Cavale-Blanche, boulevard Tanguy-Prigent, 29200 Brest, France; Université Bretagne occidentale - UFR médecine et science de la santé, EA 3878 - groupe d'étude de la thrombose de Bretagne occidentale (GETBO), 22, avenue Camille-Desmoulins CS 93837, 29238 Brest cedex 3, France; Caisse nationale assurance maladie des travailleurs salariés (CNAMTS), 50, avenue du Pr Lemierre, 75986 Paris, France.
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Fink JM, Hoffmann N, Kuesters S, Seifert G, Laessle C, Glatz T, Hopt UT, Konrad Karcz W, Marjanovic G. Banding the Sleeve Improves Weight Loss in Midterm Follow-up. Obes Surg 2017; 27:1098-1103. [PMID: 28214956 DOI: 10.1007/s11695-017-2610-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) can achieve excellent weight loss, yet sleeve dilatation with concomitant weight regain proves to be a relevant issue. Hence, additional restriction might improve results after LSG. METHODS In a retrospective matched-pair analysis, 42 patients who underwent banded LSG (BLSG) using a MiniMizer® ring between January 2012 and October 2014 were analysed regarding weight loss, complications and comorbidity. Median follow-up was 3 years. Forty-two patients who had undergone conventional LSG were selected as matched pairs. RESULTS Mean preoperative BMI was 54.93 ± 7.42 kg/m2 for BLSG and 53.46 ± 6.69 kg/m2 for LSG (Mann-Whitney P = 0.540). Total weight loss (%TWL) was significantly greater in the BLSG group 3 years after surgery (BLSG 38.22% ± 7.26; n = 26 vs. LSG 32.69 ± 9.47; n = 26; P = 0.0154). Ring placement had no relevant impact on new-onset reflux (Fisher's exact test P = 1.0) but a tendency towards reflux improvement when reflux pre-existed (odds ratio 1.96). The major side effect of ring implantation was regurgitation with over 44% of patients presenting with regurgitation >1 per week (Fisher's exact test P = 0.0019, odds ratio 18.07). CONCLUSION BLSG is a safe procedure showing similar comorbidity to conventional LSG. However, BLSG leads to a higher rate of postoperative regurgitation. Weight loss is significantly improved 3 years after surgery. Hence, additional ring implantation might be an option for increased restriction in LSG surgery.
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Affiliation(s)
- Jodok M Fink
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
| | - Natalie Hoffmann
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Simon Kuesters
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Gabriel Seifert
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Claudia Laessle
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Torben Glatz
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Ulrich T Hopt
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - W Konrad Karcz
- Department of General, Visceral, Vascular and Transplant Surgery, University of Munich, Munich, Germany
| | - Goran Marjanovic
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
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Coupaye M, Gorbatchef C, Calabrese D, Sami O, Msika S, Coffin B, Ledoux S. Gastroesophageal Reflux After Sleeve Gastrectomy: a Prospective Mechanistic Study. Obes Surg 2017; 28:838-845. [PMID: 28993985 DOI: 10.1007/s11695-017-2942-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ali M, El Chaar M, Ghiassi S, Rogers AM. American Society for Metabolic and Bariatric Surgery updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis 2017; 13:1652-1657. [PMID: 29054173 DOI: 10.1016/j.soard.2017.08.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Mohamed Ali
- Department of Surgery, University of California-Davis Medical Center, Sacramento, California
| | - Maher El Chaar
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, the Medical School of Temple University/St Luke's University Health Network, Allentown, Pennsylvania
| | - Saber Ghiassi
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Ann M Rogers
- Division of Minimally Invasive and Bariatric Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania.
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Lasnibat JP, Braghetto I, Gutierrez L, Sanchez F. SLEEVE GASTRECTOMY AND FUNDOPLICATION AS A SINGLE PROCEDURE IN PATIENTS WITH OBESITY AND GASTROESOPHAGEAL REFLUX. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2017; 30:216-221. [PMID: 29019565 PMCID: PMC5630217 DOI: 10.1590/0102-6720201700030012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/04/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Bariatric surgery in Chile has seen an exponential increase in recent years, especially in sleeve gastrectomy. Its use is currently discussed in patients suffering from gastroesophageal reflux disease. Different options have been considered for the management of these patients but up to now laparoscopic Roux-en-Y gastric bypass seems to be the best option. Sleeve gastrectomy plus concomitant fundoplication or hiatal hernia repair also has been suggested in patients having reflux or small hiatal hernia. AIM To present a cohort of obese patients with gatroesophageal reflux undergoing this procedure, which seeks to provide the benefits of both laparoscopic gastric sleeve (LSG) and antireflux surgery focused on the evaluation of presence of reflux and BMI after surgery, and to compare the result observed in this cohort with a previous group of obese patients without reflux submitted to sleeve gastrectomy alone. METHODS Retrospective case series in 15 patients who underwent this surgery between the years 2003 and 2012. Clinical records were analyzed and values of 24 hr pH monitoring, esophageal manometry and clinical outcome were recorded. Results were compared to a previous series of patients who underwent LSG. No statistical analyses were made. RESULTS Group A consisted of 15 patients submitted to LSG plus fundoplication. 93% (n=14) were female. Mean age was 46.2 years. Mean preoperative body mass index (BMI) was 33.9. All patients had altered pH monitoring and manometry preoperatively. There was one minor complication corresponding to a seroma. There was no perioperative mortality. Group B consisted of 23 obese patients who underwent LSG. These patients developed de novo reflux, hypotensive LES and esophagitis after the surgery. Group A patients showed improvement in esophageal pH monitoring and manometry at three months. During long-term follow-up, six underwent revision surgery, four for weight regain, one regained weight associated with symptomatic reflux, and one underwent re-intervention for reflux. CONCLUSIONS Good results are observed in the short-term follow up in both reflux resolution and weight loss. Nevertheless, results at long term are discouraging, with 53.3% of the patients requiring revision surgery during follow-up.
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Affiliation(s)
- Juan Pablo Lasnibat
- Department of Surgery, Faculty of Medicine, University Hospital Dr José J. Aguirre, Santiago, Chile
| | - Italo Braghetto
- Department of Surgery, Faculty of Medicine, University Hospital Dr José J. Aguirre, Santiago, Chile
| | - Luis Gutierrez
- Department of Surgery, Faculty of Medicine, University Hospital Dr José J. Aguirre, Santiago, Chile
| | - Felipe Sanchez
- Department of Surgery, Faculty of Medicine, University Hospital Dr José J. Aguirre, Santiago, Chile
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Rebecchi F, Allaix ME, Patti MG, Schlottmann F, Morino M. Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve? World J Gastroenterol 2017; 23:2269-2275. [PMID: 28428706 PMCID: PMC5385393 DOI: 10.3748/wjg.v23.i13.2269] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/15/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic sleeve gastrectomy (LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease (GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h pH monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve (both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Roux-en-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX® Reflux Management System procedure and the Stretta® procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of pH monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5th International Consensus Conference on sleeve gastrectomy.
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Do sleeve gastrectomy and gastric bypass influence treatment with proton pump inhibitors 4 years after surgery? A nationwide cohort. Surg Obes Relat Dis 2016; 13:951-959. [PMID: 28223087 DOI: 10.1016/j.soard.2016.12.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/05/2016] [Accepted: 12/14/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a common obesity-related co-morbidity that routinely is treated by continuous proton pump inhibitor (PPI) therapy. A number of concerns have been raised regarding the risk of de novo GERD or exacerbation of preexisting GERD after sleeve gastrectomy (SG). OBJECTIVE To assess PPI use at 4 years after bariatric surgery. SETTING French National Health Insurance. METHODS Data were extracted from the French National Health Insurance database. All adult obese patients who had undergone gastric bypass (GBP) (n = 8250) or SG (n = 11,923) in 2011 in France were included. Patients were considered to be on continuous PPI therapy when PPIs were dispensed≥6 times per year. Logistic regression models were used to compute odds ratios for potential risk factors for PPI reimbursement 4 years after surgery. RESULTS Overall, continuous use of PPIs increased from baseline to 4 years after SG and GBP, from 10.9% to 26.5% (P<.001) and from 11.4% to 21.9% (P<.001), respectively. Among patients who underwent PPI therapy before surgery, those who had undergone SG were more likely to continue PPI therapy 4 years after surgery compared with those who underwent GBP (72.7% versus 59.2%; P<.001). In multivariate analyses, the major risk factors for persistent continuous PPI treatment 4 years after surgery were the following: SG (odds ratio [OR] = 1.87; 95% confidence interval [CI] 1.55-2.25), higher body mass index (OR 1.85; 95% CI 1.35-2.5), and preoperative antidepressant treatment (OR 1.89; 95% CI 1.56-2.29). CONCLUSION At a nationwide scale, continuous PPI treatment is used by 1 of 10 obese patients before bariatric surgery, but by 1 of 4 patients 4 years after surgery. SG compared with GBP, higher body mass index, and other coexisting conditions are the 3 major risk factors for medium-term continuous PPI therapy.
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Poghosyan T, Lazzati A, Moszkowicz D, Danoussou D, Vychnevskaia K, Azoulay D, Czernichow S, Carette C, Bouillot JL. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: an audit of 34 patients. Surg Obes Relat Dis 2016; 12:1646-1651. [DOI: 10.1016/j.soard.2016.02.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/25/2016] [Accepted: 02/25/2016] [Indexed: 01/07/2023]
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Laparoscopic sleeve gastrectomy versus laparoscopic mini gastric bypass: One year outcomes. Int J Surg 2016; 33 Pt A:18-22. [PMID: 27452299 DOI: 10.1016/j.ijsu.2016.07.051] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/13/2016] [Accepted: 07/20/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE Sleeve gastrectomy (LSG) and mini gastric bypass (LMGB) was considered as emerging procedures but are now considered for many authors as an alternative of the Roux-Y gastric bypass because of similar percentages of weight loss and better postoperative morbidity profiles. However, studies comparing LSG and LMGB are scarce. MATERIALS AND METHODS From January 2010 to July 2014, 262 and 161 patients underwent LSG or LMGB in two centre of bariatric surgery, respectively. At one year, rate of follow-up was 88.4%. Main outcome was % of Total Weight Loss (%TWL) at one year. Propensity score matching and multivariable analyses were used to compensate for differences in some baseline characteristics. RESULTS After matching LSG (N = 136) and LMGB (N = 136) groups did not differ for initial BMI (kg/m(2)) (43.4 ± 6.5 vs. 42.8 ± 5.0; P = 0.34), % of female patients (91.9% vs. 93.4%; P = 0.64), age (years) (41.2 ± 12.3 vs. 41.2 ± 11.3; P = 0.99) and diabetes (15.4% vs. 19.9%; P = 0.34). At one year, %TWL, change in BMI and rate of stenosis were higher for LMGB group, respectively: 38.2 ± 8.4 vs. 34.3 ± 8.4 (P < 0.0001); -16.5 ± 4.6 vs. -14.9 ± 4.4 (P = 0.005) and 16.9% vs. 0% (P < 0.0001). In multivariate analyses (β coefficient), LMGB was a positive independent factor of %TWL (2.8; P = 0.008). CONCLUSION LMGB seems to have better weight loss at one year compared to LSG with higher gastric complications. Further long term studies are needed.
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Muzard L, Alvarez JC, Gbedo C, Czernichow S, Carette C. Tenofovir pharmacokinetic after sleeve-gastrectomy in four severely obese patients living with HIV. Obes Res Clin Pract 2016; 11:108-113. [PMID: 27350536 DOI: 10.1016/j.orcp.2016.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/31/2016] [Accepted: 06/11/2016] [Indexed: 01/04/2023]
Abstract
There are many unsolved questions about safety of bariatric surgery in the context of severely obese patients living with human immunodeficiency virus (HIV) and notably on antiretroviral therapy (ART) absorption. Here, we provide the first case series of tenofovir disoproxil fumarate (TDF) pharmacokinetic in four HIV-infected patients before and after sleeve-gastrectomy. Our case-series showed a transient and reversible decrease of TDF bioavailability one month after sleeve-gastrectomy without any consequences on CD4 cells and HIV viral load. More studies are needed since the impact of bariatric surgery on drug absorptions in the field of infectious diseases remains poorly investigated.
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Affiliation(s)
- Ludivine Muzard
- Department of Nutrition, Ambroise Pare Hospital (AP-HP), University of Versailles Saint Quentin en Yvelines, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| | - Jean-Claude Alvarez
- Department of Pharmacology-Toxicology, Raymond Poincare Hospital (AP-HP), INSERM U1173, University of Versailles Saint Quentin en Yvelines, 92380 Garches, France.
| | - Christophe Gbedo
- Department of Nutrition, Ambroise Pare Hospital (AP-HP), University of Versailles Saint Quentin en Yvelines, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| | - Sébastien Czernichow
- Department of Nutrition, Ambroise Pare Hospital (AP-HP), University of Versailles Saint Quentin en Yvelines, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Inserm, Population-based Epidemiologic Cohorts Unit, UMS 011, 94800 Villejuif, France.
| | - Claire Carette
- Department of Nutrition, Ambroise Pare Hospital (AP-HP), University of Versailles Saint Quentin en Yvelines, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
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