Longitudinal Evolution of Gastric Sleeve Anatomy and its Association with Esophagitis Progression Following...

Laparoscopic Sleeve Gastrectomy (LSG) is the most common bariatric procedure, effective for weight loss and comorbidity resolution. However, post-LSG Gastroesophageal Reflux Disease (GERD) and endoscopic esophagitis (EE) are significant long-term concerns, often linked to anatomical sleeve changes. Longitudinal data assessing these alterations and their association with EE progression remain limited.

This retrospective study included 539 of 754 LSG patients who underwent at least one post-operative endoscopy at a tertiary bariatric center. Demographic, clinical, and endoscopic data were analyzed. Longitudinal comparisons were performed among patients who had endoscopies at both 1-4 and ≥ 5 years post-LSG using McNemar's test, with logistic regression to identify predictors of EE.

At 1-4 years post-LSG (N = 505), EE was detected in 22.0% and GERD symptoms in 30.1%. Anatomical findings included sleeve dilatation (5.9%), hiatal hernia (HH) (7.9%), twisting (3.7%), and narrowing (0.8%), with composite abnormalities in 16.2%. GERD symptoms independently predicted early EE (OR 1.86, 95% CI 1.19-2.90, p = 0.003). At ≥ 5 years (N = 117), EE increased to 28.2% and GERD symptoms to 65.0%. In the paired subgroup (N = 83), the prevalence of GERD symptoms rose from 10.8% to 67.5% (p < 0.001), composite anatomical findings from 16.9% to 39.5% (p = 0.009), and sleeve dilatation from 7.2% to 25.3% (p = 0.004). However, early GERD, EE, HH, and composite findings did not independently predict late EE.

Long-term GERD and EE are common and progressive after LSG, with increasing anatomical changes over time. Early post-operative findings fail to predict late disease, highlighting the multifactorial evolution of post-LSG reflux and the need for ongoing surveillance.