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Endoscopic Findings 5 Years Following Sleeve Gastrectomy

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Abstract

Purpose

Laparoscopic sleeve gastrectomy (LSG) has rapidly become increasingly popular in bariatric surgery. However, in the long-term follow-up, intractable severe gastroesophageal reflux disease (GERD) after primary LSG can necessitate further investigations. The purpose of this study was to evaluate the endoscopic results at 5-year follow-up, on a cohort of patients who underwent LSG, the correlation GERD-esophagitis, and the results of pH-metry studies.

Materials and Methods

Forty-eight patients that underwent LSG (same surgeon) in our center between 2010 and 2015 were included. These patients were identified during the regular annual follow-up visit between January and July 2018 and systematic upper endoscopy was proposed. A pH-metry was carried out for the 13 patients who presented QoL altering GERD symptoms.

Results

Twenty-two patients (45.8%) with abnormal endoscopic results were identified at a mean follow-up of 62.4 months following LSG. GERD symptomatology was identified for only 13 patients (27.1%) during the follow-up compared to 18 patients (37.5%) preoperatively. Esophageal pH-metry was performed for 13 patients (27.1%). Ten patients (20.8%) (one with esophagitis and nine with QoL altering GERD) had a pathological reflux with a DeMeester score of 47 ± 8 (30–70 interval). The other three patients had normal lower than 20 DeMeester scores. GERD symptomatology was related to weight loss failure for four patients. Fourteen patients (29.2%) in our series benefited from redo surgery, with subsequent RYGB conversion (four with BE, one with severe esophagitis, and nine with persistent QoL altering GERD symptomatology). One patient has been reoperated on at day 1 postoperatively for hemorrhage from jejuno-jejunal anastomosis. Mean hospital stay of 1.92 days.

Conclusions

Our study identified an important number of asymptomatic patients with different modifications on upper endoscopy. In case of discordance between endoscopic findings and clinical presentation, additional investigation tools like pH-impedancemetry should be used. Equally, the latter should be used in case of decision to conversion for patients with severe reflux to RYGBP in order to objectify the operative indication and to achieve a reference point for follow-up.

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Authors and Affiliations

  1. Bordeaux Medicine University, Bordeaux, France

    Virgil Dimbezel, Denis Collet & Caroline Gronnier

  2. ELSAN, Clinique Saint Michel, Toulon, France

    Virgil Dimbezel, Anamaria Nedelcu, Marc Danan, Sergio Carandina & Marius Nedelcu

  3. Polyclinique de Kerio, Pontivy, France

    Virgil Dimbezel

  4. Oeso-Gastric Surgery Unit, Magellan University Hospital, Bordeaux, France

    Denis Collet & Caroline Gronnier

  5. ELSAN, Clinique Bouchard, 77 Rue de Dr. Escat,, Marseille, France

    Marius Nedelcu

  6. Centre de Chirurgie de l’Obesite (CCO), Clinique Saint Michel, Avenue de l’Orient, Toulon, France

    Marius Nedelcu

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  1. Virgil Dimbezel
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  2. Anamaria Nedelcu
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  4. Sergio Carandina
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Correspondence to Marius Nedelcu.

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Conflict of Interest

Authors V. Dimbezel, A. Nedelcu, D. Collet, and C. Gronnier have no conflicts of interest or financial ties to disclose. M. Danan, S. Carandina, and M. Nedelcu have honorarium for speaking engagements from Ethicon.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Dimbezel, V., Nedelcu, A., Danan, M. et al. Endoscopic Findings 5 Years Following Sleeve Gastrectomy. OBES SURG 30, 3847–3851 (2020). https://doi.org/10.1007/s11695-020-04757-0

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  • DOI: https://doi.org/10.1007/s11695-020-04757-0

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