Reflux, Sleeve Dilation, and Barrett's Esophagus after Laparoscopic Sleeve Gastrectomy: Long-Term Follow-Up.

Obes Surg 2017 12;27(12):3092-3101

Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.

Background: Laparoscopic sleeve gastrectomy (SG) has become the most frequently performed bariatric procedure worldwide. De novo reflux might impact patients' quality of life, requiring lifelong proton pump inhibitor medication. It also increases the risk of esophagitis and formation of Barrett's metaplasia. Besides weight regain, gastroesophageal reflux disease (GERD) is the most common reason for conversion to Roux-en-Y gastric bypass.

Methods: We performed 24-h pH metries, manometries, gastroscopies, and questionnaires focusing on reflux (GIQLI, RSI) in SG patients with a follow-up of more than 10 years who did not suffer from symptomatic reflux or hiatal hernia preoperatively.

Results: From a total of 53 patients, ten patients after adjustable gastric banding were excluded. From the remaining 43, six patients (14.0%) were converted to RYGB due to intractable reflux over a period of 130 months. Ten out of the remaining non-converted patients (n = 26) also suffered from symptomatic reflux. Gastroscopies revealed de novo hiatal hernias in 45% of the patients and Barrett's metaplasia in 15%. SG patients suffering from symptomatic reflux scored significantly higher in the RSI (p = 0.04) and significantly lower in the GIQLI (p = 0.02) questionnaire.

Conclusions: This study shows a high incidence of Barrett's esophagus and hiatal hernias at more than 10 years after SG. Its results therefore suggest maintaining pre-existing large hiatal hernia, GERD, and Barrett's esophagus as relative contraindications to SG. The limitations of this study-its small sample size as well as the fact that it was based on early experience with SG-make drawing any general conclusions about this procedure difficult.

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http://dx.doi.org/10.1007/s11695-017-2748-9DOI Listing
December 2017
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References

(Supplied by CrossRef)

J Drahos et al.
Cancer Epidemiol 2016

PW Rutte van et al.
Br J Surg 2014

H Spivak et al.
Obes Surg 2014

F Rebecchi et al.
Ann Surg 2014

S Chiu et al.
Surg Obes Relat Dis 2011

J Himpens et al.
Ann Surg 2010

M Deitel et al.
Obes Surg 2008

FB Langer et al.
Obes Surg 2010

J Homan et al.
Surg Obes Relat Dis 2015

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