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GERD leve a moderado antes de la manga: ¿Podemos predecir mejor la GERD postoperatoria?
Justine O Chinn1, Perisa Ruhi-Williams2, Mark Shacker3
1Department of Surgery, Stanford University, 500 Pasteur Dr, Palo Alto, CA, 94305, USA. jchinn1@stanford.edu.
Surgical endoscopy
|August 28, 2025
Resumen
Las puntuaciones más altas de DeMeester (≥30) o el tiempo de exposición al ácido (≥10,35%) predicen la enfermedad por reflujo gastroesofágico (ERGE) después de la gastrectomía de manga (SG). Los pacientes con estos hallazgos requieren asesoramiento cuidadoso o pueden beneficiarse de un bypass gástrico Roux-en-Y.
Área de la Ciencia:
- Cirugía bariátrica
- Gastroenterología
- Enfermedad por reflujo gastroesofágico (ERGE)
Sus antecedentes:
- La enfermedad de reflujo gastroesofágico (ERGE) es una preocupación significativa para los pacientes después de la gastrectomía de manga (SG).
- Los marcadores predictivos para la ERGE post-SG siguen siendo poco claros, lo que requiere una mayor investigación de los factores preoperatorios.
- La identificación de pacientes con riesgo de empeoramiento de los síntomas de ERGE después de la SG es crucial para el tratamiento.
Objetivo del estudio:
- Identificar las pruebas de pH inalámbricas previas a la operación y los hallazgos de la endoscopia asociados con la ERGE después de la SG.
- Establecer umbrales numéricos para la puntuación de DeMeester y el tiempo de exposición ácida (TEA) predictivos de la ERGE postoperatoria.
- Para guiar la toma de decisiones clínicas de los pacientes sometidos a SG.
Principales métodos:
- Análisis retrospectivo de pacientes con SG y estudios de pH inalámbrico preoperatorios.
- Puntuación de DeMeester definida anormal (> 14, 7) y TEA anormal (> 4%).
- Se utilizaron los análisis univariados y el índice de Youden para determinar los umbrales predictivos para la ERGE postoperatoria que requiere tratamiento con inhibidores de la bomba de protones (IPP).
Principales resultados:
- Los síntomas preoperatorios de ERGE fueron reportados por el 53, 9% de los pacientes.
- Las puntuaciones normales anormales de DeMeester y AET no fueron predictivas de la ERGE postoperatoria.
- Un umbral de puntuación de DeMeester de ≥30 o un AET de ≥10,35% es un pronóstico significativo de ERGE postoperatoria.
Conclusiones:
- Las métricas estándar de prueba de pH preoperatorio son insuficientes para predecir la ERGE post-SG.
- Las puntuaciones elevadas de DeMeester (≥30) o AET (≥10,35%) son predictivas de ERGE después de SG.
- Los pacientes con estos marcadores elevados deben recibir asesoramiento exhaustivo sobre los riesgos de ERGE o considerar el bypass gástrico Roux-en-Y.
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