The Impact of GERD Symptoms and Endoscopic RE on Early Postoperative GERD After LSG

Laparoscopic sleeve gastrectomy (LSG) may exacerbate preexisting gastroesophageal reflux disease (GERD) or induce de novo GERD. Previous studies have identified preoperative GERD as a risk factor for postoperative GERD, but the predictive value of diverse GERD assessment methods remains unclear. This study aimed to evaluate the impact of preoperative GERD-Q scores and endoscopic Los Angeles (LA) classification on early postoperative GERD symptoms after LSG, as well as their individual and combined predictive value for postoperative GERD.

This study retrospectively analyzed the prospectively collected data of patients with obesity who underwent LSG at a medical institution during a one-year period. GERD symptoms were assessed pre- and postoperatively using the GERD-Q score, with a score ≥ 8 indicating GERD symptoms. Preoperative esophagitis was evaluated via endoscopy using the LA classification.

A total of 371 individuals were included in the study, 91 (24.53%) developed GERD symptoms during follow-up. Kaplan-Meier analysis revealed an increasing cumulative incidence of GERD over time: 6.45% [95% confidence interval (CI): 3.81-9.02%] at 3 months, 21.41% (16.93-25.64%) at 6 months, and 26.69% (21.84-31.24%) at 1 year. Log-Rank Tests demonstrated significant associations between the cumulative incidence of GERD and preoperative GERD symptoms and LA classification. After performing multivariable Cox regression analysis and adjusting for age, sex, body mass index (BMI), and other confounding factors, it was found that preoperative GERD symptoms (hazard ratio [HR] = 1.88, 95% CI: 1.09-3.24, P = 0.024), preoperative RE (HR = 2.85, 95% CI: 1.81-4.50, P < 0.001) and higher LA grades (LA-A: HR = 2.83, 95% CI: 1.77-4.53, P < 0.001; LA-B/C: HR = 3.05, 95% CI: 1.07-8.72, P = 0.038) were both independent risk factors for postoperative GERD. In the symptom-endoscopy combined assessment model, risk remained significant in the only endoscopy positive group (HR = 3.22, 95% CI: 1.96-5.29, P < 0.001), the only GERD-Q positive group (HR = 2.41, 95% CI: 1.16-4.98, P = 0.018) and the double-positive group (HR = 2.65, 95% CI: 1.17-6.00, P = 0.020).

After LSG, the cumulative incidence of postoperative GERD showed a continuous upward trend with prolonged follow-up. Preoperative LA-A grades, LA-B/C grades and GERD-Q positivity were independent risk factors for postoperative GERD.