Vincenzo Pilone1,2, Salvatore Tramontano3, Michele Renzulli2, Claudio Zulli4, Luigi Schiavo5,6. 1. Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy. 2. General, Bariatric and Emergency Surgical Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy. 3. General, Bariatric and Emergency Surgical Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy. salvytra@libero.it. 4. Endoscopic Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy. 5. Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli", Naples, Italy. 6. IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy.
Abstract
BACKGROUND: Gastroesophageal reflux disease (GERD) is present in half of the obese candidates for bariatric surgery. Variability of symptoms and new onset of GERD are often debated. Prior studies have demonstrated that sleeve gastrectomy (SG) is associated with significant weight loss. OBJECTIVES: We prospectively evaluated the effect of a standardized SG technique on GERD symptoms in 104 patients. METHODS: All patients were surveyed on the presence of heartburn and/or regurgitation with a specific questionnaire (GERD-HRQL). Esophagogastroduodenoscopy (EGDS) was performed in the preoperative phase and after 12 months. RESULTS: All patients completed a 12-month follow-up. In the preoperative phase, 27.9% presented GERD symptoms (29 cases), while endoscopic findings were observed in 19.2% (20 cases). Preoperative GERD was ameliorated/solved in 65.5% of cases. The mean value of the GERD-HRQL score was significantly lower in postoperative evaluation (33.8 vs 19.4; p < 0.05). At 12-month EGDS, esophagitis was present in 13.5%, and GERD-HRQL symptoms were recorded in 10.6%. Considering patients treated until December 2015 (group 1, 44 patients) and those treated after December 2015 (group 2, 60 patients), all new clinical and endoscopic GERD diagnoses were observed in group 1; the majority of unsolved GERD cases was present in Ggoup 1 (8 vs 2; p < 0.05). CONCLUSION: Significant amelioration on preoperative GERD was confirmed after SG. New characteristics of reflux are emerging in SG patients, often asymptomatic. Standardization is necessary to define the real effect of SG on GERD.
BACKGROUND:Gastroesophageal reflux disease (GERD) is present in half of the obese candidates for bariatric surgery. Variability of symptoms and new onset of GERD are often debated. Prior studies have demonstrated that sleeve gastrectomy (SG) is associated with significant weight loss. OBJECTIVES: We prospectively evaluated the effect of a standardized SG technique on GERD symptoms in 104 patients. METHODS: All patients were surveyed on the presence of heartburn and/or regurgitation with a specific questionnaire (GERD-HRQL). Esophagogastroduodenoscopy (EGDS) was performed in the preoperative phase and after 12 months. RESULTS: All patients completed a 12-month follow-up. In the preoperative phase, 27.9% presented GERD symptoms (29 cases), while endoscopic findings were observed in 19.2% (20 cases). Preoperative GERD was ameliorated/solved in 65.5% of cases. The mean value of the GERD-HRQL score was significantly lower in postoperative evaluation (33.8 vs 19.4; p < 0.05). At 12-month EGDS, esophagitis was present in 13.5%, and GERD-HRQL symptoms were recorded in 10.6%. Considering patients treated until December 2015 (group 1, 44 patients) and those treated after December 2015 (group 2, 60 patients), all new clinical and endoscopic GERD diagnoses were observed in group 1; the majority of unsolved GERD cases was present in Ggoup 1 (8 vs 2; p < 0.05). CONCLUSION: Significant amelioration on preoperative GERD was confirmed after SG. New characteristics of reflux are emerging in SG patients, often asymptomatic. Standardization is necessary to define the real effect of SG on GERD.
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