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Published on: September 22, 2023
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Predictive Factors for Developing GERD After Sleeve Gastrectomy: Is Preoperative Endoscopy Necessary?
Omar Bellorin1, James C Senturk2,3, Mariana Vigiola Cruz1
1Department of Surgery, New York Presbyterian Hospital- Weill Cornell Medicine, New York, NY, USA.
Summary
Preoperative esophagitis and heartburn symptoms predict gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG). Routine endoscopy before SG can identify patients at higher risk for GERD, guiding surgical decisions.
Area of Science:
- Bariatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Sleeve gastrectomy (SG) is a prevalent bariatric procedure.
- Concerns exist regarding new-onset gastroesophageal reflux disease (GERD) and Barrett's esophagus post-SG.
- Preoperative endoscopic screening for GERD risk is debated.
Purpose of the Study:
- Identify preoperative endoscopic factors predicting GERD development after SG.
- Evaluate the utility of routine preoperative endoscopy in SG candidates.
Main Methods:
- Prospective study of 217 patients undergoing robotic-assisted SG.
- Preoperative endoscopy and postoperative follow-up for GERD diagnosis (esophagitis or pH test).
- Exclusion criteria: positive preoperative pH test, LA Grade B+ esophagitis, or large hiatal hernia (>5 cm).
Main Results:
- Preoperative esophagitis (endoscopic and biopsy-proven) and heartburn were significantly associated with post-SG GERD.
- Male patients were less likely to develop GERD post-SG.
- Hiatal hernia size and H. pylori infection rates did not differ between groups.
Conclusions:
- Preoperative esophagitis is a strong predictor of GERD after sleeve gastrectomy.
- Routine preoperative endoscopy is valuable for identifying patients who may benefit from alternative bariatric procedures.
- Clinical and endoscopic findings should guide surgical recommendations to mitigate GERD risk.
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