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Reflux, Sleeve Dilation, and Barrett’s Esophagus after Laparoscopic Sleeve Gastrectomy: Long-Term Follow-Up

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Abstract

Background

Laparoscopic sleeve gastrectomy (SG) has become the most frequently performed bariatric procedure worldwide. De novo reflux might impact patients’ quality of life, requiring lifelong proton pump inhibitor medication. It also increases the risk of esophagitis and formation of Barrett’s metaplasia. Besides weight regain, gastroesophageal reflux disease (GERD) is the most common reason for conversion to Roux-en-Y gastric bypass.

Methods

We performed 24-h pH metries, manometries, gastroscopies, and questionnaires focusing on reflux (GIQLI, RSI) in SG patients with a follow-up of more than 10 years who did not suffer from symptomatic reflux or hiatal hernia preoperatively.

Results

From a total of 53 patients, ten patients after adjustable gastric banding were excluded. From the remaining 43, six patients (14.0%) were converted to RYGB due to intractable reflux over a period of 130 months. Ten out of the remaining non-converted patients (n = 26) also suffered from symptomatic reflux. Gastroscopies revealed de novo hiatal hernias in 45% of the patients and Barrett’s metaplasia in 15%. SG patients suffering from symptomatic reflux scored significantly higher in the RSI (p = 0.04) and significantly lower in the GIQLI (p = 0.02) questionnaire.

Conclusions

This study shows a high incidence of Barrett’s esophagus and hiatal hernias at more than 10 years after SG. Its results therefore suggest maintaining pre-existing large hiatal hernia, GERD, and Barrett’s esophagus as relative contraindications to SG. The limitations of this study—its small sample size as well as the fact that it was based on early experience with SG—make drawing any general conclusions about this procedure difficult.

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Author information

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria

    Daniel Moritz Felsenreich, Ronald Kefurt, Ivan Kristo, Gerhard Prager & Felix B. Langer

  2. Department for Surgery, Hospital Rudolfsstiftung, Vienna, Austria

    Martin Schermann

  3. Department for Surgery, Hospital Hollabrunn, Hollabrunn, Austria

    Philipp Beckerhinn

  4. Division of Endocrinology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria

    Michael Krebs

Authors
  1. Daniel Moritz Felsenreich
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  2. Ronald Kefurt
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  3. Martin Schermann
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  4. Philipp Beckerhinn
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  5. Ivan Kristo
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  6. Michael Krebs
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  7. Gerhard Prager
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  8. Felix B. Langer
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Corresponding author

Correspondence to Gerhard Prager.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the research committee of the Vienna Medical University and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors DM Felsenreich, R Kefurt, M Schermann, P Beckerhinn, I Kristo, M Krebs, G Prager, and FB Langer declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

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Felsenreich, D.M., Kefurt, R., Schermann, M. et al. Reflux, Sleeve Dilation, and Barrett’s Esophagus after Laparoscopic Sleeve Gastrectomy: Long-Term Follow-Up. OBES SURG 27, 3092–3101 (2017). https://doi.org/10.1007/s11695-017-2748-9

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  • DOI: https://doi.org/10.1007/s11695-017-2748-9

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