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

Background Laparoscopic sleeve gastrectomy (LSG) has become the preferred bariatric procedure in many countries. However, there is one shortcoming of LSG in the long-term follow-up and this is the onset of GERD and erosive esophagitis (EE). Current evidence of the effect of SG on GERD did not consol...

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Published in:Obesity surgery 2019-01, Vol.29 (1), p.207-214
Main Authors: Lim, Chin Hong, Lee, Phong Ching, Lim, Eugene, Tan, Jeremy, Chan, Weng Hoong, Tan, Hong Chang, Ganguly, Sonali, Tham, Kwang Wei, Eng, Alvin
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Endoscopy
Esophagitis - epidemiology
Esophagitis - etiology
Female
Gastrectomy - adverse effects
Gastrectomy - methods
Gastrectomy - statistics & numerical data
Gastroesophageal Reflux - epidemiology
Gastroesophageal Reflux - etiology
Hernia, Hiatal - epidemiology
Hernia, Hiatal - etiology
Humans
Incidence
Laparoscopy - adverse effects
Laparoscopy - methods
Laparoscopy - statistics & numerical data
Male
Medicine
Medicine & Public Health
Middle Aged
Obesity - epidemiology
Obesity - surgery
Obesity, Morbid - epidemiology
Obesity, Morbid - surgery
Original Contributions
Peptic Ulcer - epidemiology
Peptic Ulcer - etiology
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Postoperative Period
Prevalence
Retrospective Studies
Singapore - epidemiology
Surgeons
Surgery
Young Adult
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Summary:Background Laparoscopic sleeve gastrectomy (LSG) has become the preferred bariatric procedure in many countries. However, there is one shortcoming of LSG in the long-term follow-up and this is the onset of GERD and erosive esophagitis (EE). Current evidence of the effect of SG on GERD did not consolidate to a consensus. In this study, we objectively evaluate the incidence of EE 1 year post-LSG with upper endoscopy (EGD) and try to identify the significant variables and possible underlying mechanisms of the EE post-LSG. Methods Over a period of 5 years (2011–2016) at Singapore General Hospital, we retrospectively reviewed a prospectively collected database of a cohort of patients whom had LSG by a single surgeon who routinely performed EGD pre-operative and 1 year post-operative to assess EE and hiatal hernia. Patient’s endoscopic findings and demographic and anthropometric data were analyzed. Results We identified a total of 97 obese patients who underwent LSG at our hospital by studied surgeon. Sixty-three patients (64.9% of original sample) were finally evaluated in the present study, 40 (59.7%) of whom were female. The mean (range) age of patients was 38.2 (18–66) years, and mean BMI was 36.3 ± 4.1 kg/m 2 . Median time to follow-up EGD was 13 months (range, 12–15). Following LSG, there was a significant decrease in both BMI (42.1 ± 1.2 vs. 29.9 ± 1.0 kg/m 2 ) and percentage excess weight loss of 56.6 ± 3.6%. The prevalence of EE on endoscopy increased from 9 (14.3%) to 28 (44.4%) patients. Of which 15 (23.8%) were grade A, 11 (17.5%) were grade B, and 2 (3.2%) were grade C. There was no correlation between GERD symptoms with EE; however, our study found a trend suggesting higher prevalence of EE with a sleeve diameter measuring > 2 cm wide ( p  = 0.069). Conclusion Although LSG is effective in treating obesity and its metabolic syndromes, the prevalence of EE increased significantly 1 year after the surgery. Since we do not fully understand the long-term impact of chronic esophagitis in post-sleeve population, we recommend follow-up EGD assessment post-operatively and treat the esophagitis if present.
ISSN:0960-8923
1708-0428
DOI:10.1007/s11695-018-3509-0