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Published on: August 21, 2021
Conversion to Roux-en-Y gastric bypass as an effective treatment for postsleeve reflux: Identifying risk factors for
Agustina A Pontecorvo1, Jorge Cornejo1, Tamar Tsenteradze1
1Division of Advanced Gastrointestinal and Bariatric Surgery, Department of General Surgery, Mayo Clinic, Jacksonville, FL, USA.
Background:
Roux-en-Y gastric bypass (RYGB) is the preferred revisional procedure for the resolution of gastroesophageal reflux disease (GERD) following sleeve gastrectomy (SG). Although several studies have demonstrated effective reflux resolution after conversion to RYGB, a subset of patients continues to experience persistent symptoms. Data specifically addressing factors associated with refractory reflux after conversion remain limited.
Objectives:
The primary aim of this study is to identify factors associated with persistent reflux symptoms following conversion from SG to RYGB.
Setting:
University hospital.
Methods:
A retrospective review was conducted of patients who underwent conversion from SG to RYGB at our institution between 2013 and 2024. Patient records were reviewed to assess reflux-related symptoms, proton pump inhibitor (PPI) use, and weight-related outcomes. Univariate and multivariate regression analyses were performed to identify factors associated with persistent postoperative reflux.
Results:
A total of 109 patients were included. Preoperative endoscopy identified esophagitis in 45.9% and sleeve anatomical abnormalities (angulation or stricture) in 17.4%. At baseline, 80% of patients used daily PPI therapy, including 43.5% on twice-daily dosing. After conversion, reflux symptoms resolved and PPI therapy was discontinued in 75.5% of patients, whereas 24.5% had persistent symptoms requiring maximum-dose PPI at last follow-up. On univariate analysis, sleeve angulation (odds ratio [OR] = 7.7), pre-SG GERD (OR = 2.7), preoperative dysphagia (OR = 3.9), and twice-daily PPI use (OR = 2.6) were associated with persistent reflux, whereas conversion for weight regain (OR = .27) was protective. Sleeve angulation remained independently associated with persistent reflux on multivariate analysis (adjusted OR = 6.2).
Conclusion:
Persistent reflux following conversion from SG to RYGB remains clinically significant. Comprehensive preoperative assessment is essential to identify patients at increased risk for persistent symptoms and to optimize patient selection and counseling.
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