Does Sleeve Gastrectomy Expose the Distal Esophagus to Severe Reflux?: A Systematic Review and Meta-analysis

Kai Tai Derek Yeung, Nicholas Penney, Leanne Ashrafian, Ara Darzi, Hutan Ashrafian, Kai Tai Derek Yeung, Nicholas Penney, Leanne Ashrafian, Ara Darzi, Hutan Ashrafian

Abstract

Objective: The aim of this study was to appraise the prevalence of gastroesophageal reflux disease (GERD), esophagitis, and Barrett's esophagus (BE) after sleeve gastrectomy (SG) through a systematic review and meta-analysis.

Background: The precise prevalence of new-onset or worsening GERD after SG is controversial. Subsequent esophagitis and BE can be a serious unintended sequalae. Their postoperative prevalence remains unclear.

Methods: A systematic literature search was performed to identify studies evaluating postoperative outcomes in primary SG for morbid obesity. The primary outcome was prevalence of GERD, esophagitis, and BE after SG. Meta-analysis was performed to calculate combined prevalence.

Results: A total of 46 studies totaling 10,718 patients were included. Meta-analysis found that the increase of postoperative GERD after sleeve (POGAS) was 19% and de novo reflux was 23%. The long-term prevalence of esophagitis was 28% and BE was 8%. Four percent of all patients required conversion to RYGB for severe reflux.

Conclusions: The postoperative prevalence of GERD, esophagitis, and BE following SG is significant. Symptoms do not always correlate with the presence of pathology. As the surgical uptake of SG continues to increase, there is a need to ensure that surgical decision-making and the consent process for this procedure consider these long-term complications while also ensuring their postoperative surveillance through endoscopic and physiological approaches. The long-term outcomes of this commonly performed bariatric procedure should be considered alongside its weight loss and metabolic effects.

References

    1. Higa KH, Welbourn J, Dixon R, et al. P. IFSO Global Registry Report. International Federation for the Surgery of Obesity and Metabolic Disorders. 2017. Available at: . Accessed August 1, 2018.
    1. Berger ER, Huffman KM, Fraker T, et al. Prevalence and risk factors for bariatric surgery readmissions: findings from 130,007 admissions in the metabolic and bariatric surgery accreditation and quality improvement program. Ann Surg 2018; 267:122–131.
    1. Gagner M, Hutchinson C, Rosenthal R. Fifth International Consensus Conference: current status of sleeve gastrectomy. Surg Obes Relat Dis 2016; 12:750–756.
    1. Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA 2018; 319:255–265.
    1. Salminen P, Helmio M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. Jama 2018; 319:241–254.
    1. Chang DM, Lee WJ, Chen JC, et al. Thirteen-year experience of laparoscopic sleeve gastrectomy: surgical risk, weight loss, and revision procedures. Obes Surg 2018; 28:2991–2997.
    1. Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett's esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis 2017; 13:568–574.
    1. Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg 2010; 252:319–324.
    1. Rebecchi F, Allaix ME, Giaccone C, et al. Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation. Ann Surg 2014; 260:909–914.
    1. Berry MA, Urrutia L, Lamoza P, et al. Sleeve gastrectomy outcomes in patients with BMI between 30 and 35-3 years of follow-up. Obes Surg 2018; 28:649–655.
    1. Wright FG, Duro A, Medici JR, et al. Esophageal adenocarcinoma five years after laparoscopic sleeve gastrectomy. A case report. Int J Surg Case Rep 2017; 32:47–50.
    1. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010; 8:336–341.
    1. GA Wells BS, D O’Connell, J Peterson, V Welch, M Losos, P Tugwell. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses; 2018. Available at: . Accessed August 1, 2018.
    1. Abd Ellatif ME, Abdallah E, Askar W, et al. Long term predictors of success after laparoscopic sleeve gastrectomy. Int J Surg 2014; 12:504–508.
    1. Albanopoulos K, Tsamis D, Natoudi M, et al. The impact of laparoscopic sleeve gastrectomy on weight loss and obesity-associated comorbidities: the results of 3 years of follow-up. Surg Endosc 2016; 30:699–705.
    1. Alexandrou A, Athanasiou A, Michalinos A, et al. Laparoscopic sleeve gastrectomy for morbid obesity: 5-year results. Am J Surg 2015; 209:230–234.
    1. Althuwaini S, Bamehriz F, Aldohayan A, et al. Prevalence and predictors of gastroesophageal reflux disease after laparoscopic sleeve gastrectomy. Obes Surg 2018; 28:916–922.
    1. Angrisani L, Santonicola A, Hasani A, et al. Five-year results of laparoscopic sleeve gastrectomy: effects on gastroesophageal reflux disease symptoms and co-morbidities. Surg Obes Relat Dis 2016; 12:960–968.
    1. Arman GA, Himpens J, Dhaenens J, et al. Long-term (11+years) outcomes in weight, patient satisfaction, comorbidities, and gastroesophageal reflux treatment after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2016; 12:1778–1786.
    1. Barry RG, Amiri FA, Gress TW, et al. Laparoscopic vertical sleeve gastrectomy: a 5-year veterans affairs review. Medicine 2017; 96:e7508.
    1. Bohdjalian A, Langer FB, Shakeri-Leidenmuhler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg 2010; 20:535–540.
    1. Borbely Y, Schaffner E, Zimmermann L, et al. De novo gastroesophageal reflux disease after sleeve gastrectomy: role of preoperative silent reflux. Surg Endosc 2019; 33:789–793.
    1. Boza C, Daroch D, Barros D, et al. Long-term outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure. Surg Obes Relat Dis 2014; 10:1129–1133.
    1. Braghetto I, Csendes A. Prevalence of Barrett's esophagus in bariatric patients undergoing sleeve gastrectomy. Obes Surg 2016; 26:710–714.
    1. Burgerhart JS, Schotborgh CA, Schoon EJ, et al. Effect of sleeve gastrectomy on gastroesophageal reflux. Obes Surg 2014; 24:1436–1441.
    1. Carabotti M, Silecchia G, Greco F, et al. Impact of laparoscopic sleeve gastrectomy on upper gastrointestinal symptoms. Obes Surg 2013; 23:1551–1557.
    1. Carter PR, LeBlanc KA, Hausmann MG, et al. Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2011; 7:569–572.
    1. Castagneto Gissey L, Casella Mariolo JR, Genco A, et al. 10-year follow-up after laparoscopic sleeve gastrectomy: outcomes in a monocentric series. Surg Obes Relat Dis 2018; 14:1480–1487.
    1. Catheline JM, Fysekidis M, Bachner I, et al. Five-year results of sleeve gastrectomy. J Visc Surg 2013; 150:307–312.
    1. Chuffart E, Sodji M, Dalmay F, et al. Long-term results after sleeve gastrectomy for gastroesophageal reflux disease: a single-center French study. Obes Surg 2017; 27:2890–2897.
    1. Coupaye M, Gorbatchef C, Calabrese D, et al. Gastroesophageal reflux after sleeve gastrectomy: a prospective mechanistic study. Obes Surg 2018; 28:838–845.
    1. Dakour Aridi H, Asali M, Fouani T, et al. Gastroesophageal reflux disease after laparoscopic sleeve gastrectomy with concomitant hiatal hernia repair: an unresolved question. Obes Surg 2017; 27:2898–2904.
    1. Felsenreich DM, Ladinig LM, Beckerhinn P, et al. Update: 10 years of sleeve gastrectomy—the first 103 patients. Obes Surg 2018; 28:3586–3594.
    1. Flolo TN, Andersen JR, Kolotkin RL, et al. Five-year outcomes after vertical sleeve gastrectomy for severe obesity: a prospective cohort study. Obes Surg 2017; 27:1944–1951.
    1. Gadiot RP, Biter LU, van Mil S, et al. Long-term results of laparoscopic sleeve gastrectomy for morbid obesity: 5 to 8-year results. Obes Surg 2017; 27:59–63.
    1. Garg H, Aggarwal S, Misra MC, et al. Mid to long term outcomes of laparoscopic sleeve gastrectomy in Indian population: 3-7 year results—a retrospective cohort study. Int J Surg 2017; 48:201–209.
    1. Georgia D, Stamatina T, Maria N, et al. 24-h multichannel intraluminal impedance PH-metry 1 year after laparocopic sleeve gastrectomy: an objective assessment of gastroesophageal reflux disease. Obes Surg 2017; 27:749–753.
    1. Hendricks L, Alvarenga E, Dhanabalsamy N, et al. Impact of sleeve gastrectomy on gastroesophageal reflux disease in a morbidly obese population undergoing bariatric surgery. Surg Obes Relat Dis 2016; 12:511–517.
    1. Hirth DA, Jones EL, Rothchild KB, et al. Laparoscopic sleeve gastrectomy: long-term weight loss outcomes. Surg Obes Relat Dis 2015; 11:1004–1007.
    1. Howard DD, Caban AM, Cendan JC, et al. Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Surg Obes Relat Dis 2011; 7:709–713.
    1. Kehagias I, Spyropoulos C, Karamanakos S, et al. Efficacy of sleeve gastrectomy as sole procedure in patients with clinically severe obesity (BMI </=50 kg/m(2)). Surg Obes Relat Dis 2013; 9:363–369.
    1. Kowalewski PK, Olszewski R, Waledziak MS, et al. Long-term outcomes of laparoscopic sleeve gastrectomy—a single-center, retrospective study. Obes Surg 2018; 28:130–134.
    1. Lemaitre F, Leger P, Nedelcu M, et al. Laparoscopic sleeve gastrectomy in the South Pacific. Retrospective evaluation of 510 patients in a single institution. Int J Surg 2016; 30:1–6.
    1. Menenakos E, Stamou KM, Albanopoulos K, et al. Laparoscopic sleeve gastrectomy performed with intent to treat morbid obesity: a prospective single-center study of 261 patients with a median follow-up of 1 year. Obes Surg 2010; 20:276–282.
    1. Nocca D, Loureiro M, Skalli EM, et al. Five-year results of laparoscopic sleeve gastrectomy for the treatment of severe obesity. Surg Endosc 2017; 31:3251–3257.
    1. Pok EH, Lee WJ, Ser KH, et al. Laparoscopic sleeve gastrectomy in Asia: long term outcome and revisional surgery. Asian J Surg 2016; 39:21–28.
    1. Rawlins L, Rawlins MP, Brown CC, et al. Sleeve gastrectomy: 5-year outcomes of a single institution. Surg Obes Relat Dis 2013; 9:21–25.
    1. Sharma A, Aggarwal S, Ahuja V, et al. Evaluation of gastroesophageal reflux before and after sleeve gastrectomy using symptom scoring, scintigraphy, and endoscopy. Surg Obes Relat Dis 2014; 10:600–605.
    1. Sheppard CE, Sadowski DC, de Gara CJ, et al. Rates of reflux before and after laparoscopic sleeve gastrectomy for severe obesity. Obes Surg 2015; 25:763–768.
    1. Singla V, Aggarwal S, Garg H, et al. Outcomes in super obese patients undergoing laparoscopic sleeve gastrectomy. J Laparoendosc Adv Surg Tech A 2018; 28:256–262.
    1. Soricelli E, Casella G, Baglio G, et al. Lack of correlation between gastroesophageal reflux disease symptoms and esophageal lesions after sleeve gastrectomy. Surg Obes Relat Dis 2018; 14:751–756.
    1. Tai CM, Huang CK, Lee YC, et al. Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults. Surg Endosc 2013; 27:1260–1266.
    1. Viscido G, Gorodner V, Signorini F, et al. Laparoscopic sleeve gastrectomy: endoscopic findings and gastroesophageal reflux symptoms at 18-month follow-up. J Laparoendosc Adv Surg Tech A 2018; 28:71–77.
    1. Gyawali CP, Kahrilas PJ, Savarino E, et al. Modern diagnosis of GERD: the Lyon Consensus. Gut 2018; 67:1351–1362.
    1. Epstein F. Mechanisms of disease. N Engl J Med 1997; 336:1575.
    1. Reynolds JL, Zehetner J, Shiraga S, et al. Intraoperative assessment of the effects of laparoscopic sleeve gastrectomy on the distensibility of the lower esophageal sphincter using impedance planimetry. Surg Endosc 2016; 30:4904–4909.
    1. Mion F, Tolone S, Garros A, et al. High-resolution impedance manometry after sleeve gastrectomy: increased intragastric pressure and reflux are Frequent Events. Obes Surg 2016; 26:2449–2456.
    1. van Rijn S, Rinsma NF, van Herwaarden-Lindeboom MY, et al. Effect of vagus nerve integrity on short and long-term efficacy of antireflux surgery. Am J Gastroenterol 2016; 111:508–515.
    1. Garay M, Balague C, Rodriguez-Otero C, et al. Influence of antrum size on gastric emptying and weight-loss outcomes after laparoscopic sleeve gastrectomy (preliminary analysis of a randomized trial). Surg Endosc 2018; 32:2739–2745.
    1. Barrett NR. Hiatus hernia: a review of some controversial points. Br J Surg 1954; 42:231–243.
    1. Ellis FH Jr, Lyons WS, Olsen AM. The gastroesophageal sphincter mechanism: a review. Proc Staff Meet Mayo Clin 1956; 31:605–614.
    1. Collis JL, Kelly TD, Wiley AM. Anatomy of the crura of the diaphragm and the surgery of hiatus hernia. Thorax 1954; 9:175–189.
    1. Braune W. Topographisch-anatomischer Atlas nach Durchsch- nitten an gefrorene Cadavern. Leibzig: Kleine Ausgabe; 1878.
    1. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013; 108:308–328.
    1. De Luca M, Angrisani L, Himpens J, et al. Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 2016; 26:1659–1696.
    1. DuPree CE, Blair K, Steele SR, et al. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surg 2014; 149:328–334.
    1. Gorodner V, Buxhoeveden R, Clemente G, et al. Barrett's esophagus after Roux-en-Y gastric bypass: does regression occur? Surg Endosc 2017; 31:1849–1854.
    1. Andrew B, Alley JB, Aguilar CE, et al. Barrett's esophagus before and after Roux-en-Y gastric bypass for severe obesity. Surg Endosc 2018; 32:930–936.
    1. Ashrafian H, Ahmed K, Rowland SP, et al. Metabolic surgery and cancer: protective effects of bariatric procedures. Cancer 2011; 117:1788–1799.
    1. Mackenzie H, Markar SR, Askari A, et al. Obesity surgery and risk of cancer. Br J Surg 2018; 105:1650–1657.
    1. Souza RF. Reflux esophagitis and its role in the pathogenesis of Barrett's metaplasia. J Gastroenterol 2017; 52:767–776.
    1. Gagner M. Is sleeve gastrectomy always an absolute contraindication in patients with Barrett's? Obes Surg 2016; 26:715–717.
    1. Rebecchi F, Allaix ME, Patti MG, et al. Gastroesophageal reflux disease and morbid obesity: to sleeve or not to sleeve? World J Gastroenterol 2017; 23:2269–2275.

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