Esophagitis evolution after sleeve gastrectomy or gastric bypass in consecutive cases

Area of Science:

• Gastroenterology
• Bariatric Surgery
• Digestive Health

Background:

• Erosive esophagitis (EE) is esophageal mucosal damage linked to GERD, potentially leading to Barrett's esophagus and adenocarcinoma.
• Obesity is a rising factor in EE, Barrett's esophagus, and adenocarcinoma.
• The correlation between GERD symptoms and endoscopic findings is poor (40% predictive value).

Purpose of the Study:

• To determine the incidence of EE one year after sleeve gastrectomy (SG) and gastric bypass (GBP).
• To objectively assess the impact of SG and GBP on esophageal mucosa.
• To compare EE evolution between SG and GBP procedures.

Main Methods:

• Retrospective review of a prospective database of consecutive primary SG and GBP cases (2014-2016).
• Comparison of EE evolution between patients with adequate versus inadequate weight loss.
• Statistical analysis using Chi-square and Student's t-tests for categorical and continuous variables, respectively.

Main Results:

• 227 patients included: 64.8% SG (n=147) and 35.2% GBP (n=80).
• EE decreased post-GBP (54% to 26.2%, p=0.002) and increased post-SG (8.2% to 30%, p=0.04).
• Barrett's esophagus decreased post-GBP (7.5% to 5%, p=0.001); no significant difference in EE evolution based on weight loss adequacy.

Conclusions:

• One-year post-surgery, SG shows a higher incidence of EE compared to GBP.
• GBP may improve EE, whereas SG appears to exacerbate it.
• These outcomes are potentially associated with gastroesophageal reflux disease (GERD).