High rate of de novo esophagitis 5 years after sleeve gastrectomy: a prospective multicenter study in Spain

Autor: Hermelinda Pardellas, Sagrario Martínez, Asunción Acosta, Margarida Vives Espelta, Ester Martín García-Alementa, Ismael Diez del Val, Daniel Del Castillo, Raquel Gómez Sánchez, Sergio Ortiz Isabial, Juana Morante, Julia de Manuel Moreno, María de los Angeles Mayo-Ossorio, Antonio José Torres García, Mónica García, José Vicente Ferrer, F. Xavier González-Argente, Ramon Vilallonga, Antonio L Picardo, Alberto Pagan, J. Daniel Sánchez, Javier Ortiz Lacorzana
Rok vydání: 2022
Předmět:
Zdroj: Surgery for Obesity and Related Diseases. 18:546-554
ISSN: 1550-7289
DOI: 10.1016/j.soard.2021.11.011
Popis: Background Major concerns years after the sleeve gastrectomy (SG) include weight regain, development of hiatal hernia (HH) and gastro esophageal reflux disease (GERD), with esophagitis and Barrett's esophagus (BE). Both problems could be related, and the incidence of asymptomatic patients is troubling. Goal To study the incidence of reflux symptoms, esophagitis, BE, hiatal hernia and asymptomatic pathology and their relationship with weight regain in patients 5 years after undergoing SG at different bariatric centers in Spain. Setting Public and private hospitals with bariatric surgery units. Patients and method Prospective, multicenter, non-randomized study involving 13 Spanish hospitals with a cumulative experience of 4500 patients having undergone the SG procedure and patients who had been subjected to the procedure at least 5 years previously along with preoperative gastroscopy. The clinical history, preoperative gastroscopy, and technical details of the SG were recorded. A specific clinical questionnaire was given that recorded the intake volume, perception of satiety and gastroesophageal reflux (GER) symptoms. Gastroscopy, pH-metry and manometry studies were carried out, and the data analyzed statistically. The study has been authorized by the official Spanish ethics committee "CEI/CEIm Hospital Universitario Gran Canaria Dr Negrin", with the code 2019-216-1. Results 105 patients who underwent SG and who had with at least 5 years of follow-up were included. All procedures were performed laparoscopically. The mean age of patients was 51.1 years and 70.5% were women. The mean characteristics of the SG procedure were a 37.2 French probe, at 4.6 cm from the pylorus, and a crura closure was performed in 5 cases. There were no major complications (Clavien Dindo> 3) or deaths. The average preoperative Body Mass Index (BMI) was 46.3 kg/m2, the minimum reached was 20.6 kg/m2, while the average after 5 years was of 34.5 kg/m2. The presence of GER, hiatal hernia and esophagitis symptoms went from 17.1%, 28.6% and 5.7%, respectively, before the SG to 76%, 30,5% and 31,4% respectively, 5 years after the procedure. Symptoms persisted over the years in 37,1% of cases and presented de novo in 52,8% of cases. 53% of manometries (n=27, total 51) and 64% of pH-metries (n=32, total 53) (DeMeester average score was 65) were pathological 5 years after the procedure. Concerning gastroscopies, 5 years after the procedure, HH was found in 33 patients (30,5% of total) and esophagitis in 32 patients (31,4% of total). 80 patients (76%) had GER symptoms, and 25 patients (24%) were asymptomatics. Only one patient (0,9%) developed BE. Conclusion Our study has confirmed a high rate of both “persistent” and “de novo” esophagitis and hiatal hernia, many of which were asymptomatic, 5 years after SG had been performed. Weight regain and a striking increase in gastric capacity are risk factors indicative of esophagitis, even when patients are asymptomatic. We consider a control gastroscopy and the preventive use of proton pump inhibitors (PPIs) necessary in these cases, regardless of symptoms. We recommend a control gastroscopy should be performed in all cases, regardless of symptoms, 5 years after SG. Further studies are needed to validate these recommendations.
Databáze: OpenAIRE
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