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Imanbayeva A, Zhakiev B, Yelemessov A, Adaibayev K, Tussupkaliyeva K, Turebayev D, Urazova S, Mamesheva L, Afshar A. Assessing academic impact through a bibliometrics analysis: Gastroesophageal reflux disease in the context of obesity treatment and bariatric surgery. SAGE Open Med 2025; 13:20503121251336304. [PMID: 40353199 PMCID: PMC12064900 DOI: 10.1177/20503121251336304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Accepted: 04/04/2025] [Indexed: 05/14/2025] Open
Abstract
Aims The global rise in obesity rates has led to increased use of bariatric surgery, which can potentially exacerbate or induce gastroesophageal reflux disease. This study aimed to assess the academic impact and trends in research on gastroesophageal reflux disease in the context of obesity treatment and bariatric surgery through a comprehensive bibliometric analysis. Materials and methods A bibliometric analysis was conducted using data from Web of Science and Scopus databases, covering publications from 1993 to 2024. The study utilized the Bibliometrix R package to analyze publication trends, collaborative networks, and research topics. Results The analysis encompassed 257 documents from 82 sources, with 6192 total citations and an 8.2% annual growth rate in publications. The United States emerged as the leading contributor with 90 publications. Key research topics included bariatric surgery, sleeve gastrectomy, and gastroesophageal reflux disease, with increasing focus on complications and revisional bariatric surgery in recent years. Two main research clusters were identified: one focusing on general health aspects and demographics, and another on specialized bariatric procedures and outcomes. However, the analysis is constrained by its reliance on data from only two bibliographic databases, which may not encompass all pertinent studies, and by a geographic bias toward high-income countries. Moreover, our deep literature reviews highlighted that obesity is a known risk factor for gastroesophageal reflux disease, and while Roux-en-Y gastric bypass often reduces gastroesophageal reflux disease symptoms, sleeve gastrectomy may exacerbate or cause de novo gastroesophageal reflux disease postoperatively. Conclusions This bibliometric study reveals a significant increase in research activity on gastroesophageal reflux disease in relation to obesity treatment and bariatric surgery, particularly since 2017. The findings highlight the growing importance of this field and the need for continued international research efforts to optimize surgical protocols and improve patient outcomes.
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Affiliation(s)
- Akbayan Imanbayeva
- Department of Surgical Diseases With Urology No. 2, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Bazylbek Zhakiev
- Department of Surgical Diseases With Urology No. 2, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Asset Yelemessov
- Department of Surgical Diseases With Urology No. 2, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Kairat Adaibayev
- Department of Surgery With Courses in Angiosurgery and Plastic Surgery, NAO Astana Medical University, Kazakhstan
| | - Kymbat Tussupkaliyeva
- Department of Epidemiology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Dulat Turebayev
- Department of Surgery With Courses in Angiosurgery and Plastic Surgery, NAO Astana Medical University, Kazakhstan
| | - Saltanat Urazova
- Department of Family Medicine No. 3, NAO Astana Medical University, Kazakhstan
| | - Laura Mamesheva
- Department of Surgery With Courses in Angiosurgery and Plastic Surgery, NAO Astana Medical University, Kazakhstan
| | - Alireza Afshar
- Department of Surgical Diseases With Urology No. 2, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
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Mansour AMFM, Ghazal AEHA, Kassem MI, Ugliono E, Morino M, ElKeleny MR. Impact of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Esophageal Physiology and Gastroesophageal Reflux Disease: A Prospective Study. Obes Surg 2025; 35:1702-1717. [PMID: 40227539 PMCID: PMC12065729 DOI: 10.1007/s11695-025-07818-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 03/06/2025] [Accepted: 03/18/2025] [Indexed: 04/15/2025]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most commonly performed bariatric surgical procedures. The effectiveness of these operations on weight control is well established; however, their impact on esophageal physiology is still under evaluation. The aim of this study is to evaluate the consequences of LSG and LRYGB on esophageal physiology, especially concerning reflux. METHODS This prospective study involved 30 patients with severe obesity; 15 underwent LSG, and 15 had LRYGB. Conducted between 2021 and 2023 in Turin, Italy, the study employed preoperative and 1-year postoperative assessments of esophageal function using conventional esophageal manometry, 24-h multichannel intraluminal impedance-pH (MII-pH), upper gastrointestinal series, upper endoscopy, and a validated questionnaire to assess outcomes related to esophageal and lower esophageal sphincter (LES) functions and reflux. RESULTS Both groups experienced significant reductions in weight and body mass index, with p-values < 0.001 for both measures. The LRYGB group achieved a significantly higher percentage of excess weight loss compared to the LSG group, with a p-value of < 0.001. In the LSG group, GERD symptoms remained unchanged postoperatively (p = 0.687), with 26.7% using proton pump inhibitors (PPIs) before and after surgery, while in the LRYGB group, GERD symptoms and PPIs use significantly decreased from 53.3 to 6.7% (p = 0.016). Quality of life improved significantly in both groups, with a p-value of 0.001. In the LRYGB group only, esophagitis significantly decreased from 53.3 to 6.7% (p = 0.007), and barium studies showed a significant reduction in reflux signs from 66.7% preoperatively to none postoperatively (p = 0.002). Multichannel intraluminal impedance-pH monitoring revealed significant reductions in reflux metrics for LRYGB group only: total refluxes decreased from 29.0 to 15.0, acidic refluxes from 12.0 to 8.0, and the DeMeester score from 4.70 to 3.70 (p = 0.026, 0.033, and 0.029, respectively). Regarding the manometric parameters, significant changes were observed in the LSG group: total LES length decreased from 34.0 to 31.33 mm (p = 0.027) and residual pressure increased from 2.0 to 4.0 mmHg (p = 0.012), also peristaltic wave amplitude decreased from 98.20 to 52.93 mmHg (p < 0.001), while in the LRYGB group, only the LES residual pressure significantly increased from 2.0 to 4.0 mmHg (p = 0.006). CONCLUSIONS LSG and LRYGB are effective for weight loss and improving quality of life. Sleeve gastrectomy controls reflux, with new cases being rare. Advanced diagnostics are key when standard tests are insufficient.
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Abu Dayyeh BK, Al Annan K, Aburumman R, Abedalqader T, Mrad R, Gala K, Brunaldi V, Ghanem OM. Mechanisms of Gastroesophageal Reflux Post-Roux-en-Y Gastric Bypass: Universal Alteration of the Antireflux Barrier is the Culprit. Surg Laparosc Endosc Percutan Tech 2025:00129689-990000000-00316. [PMID: 40202306 DOI: 10.1097/sle.0000000000001366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Accepted: 03/17/2025] [Indexed: 04/10/2025]
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) symptoms and the use of proton pump inhibitors (PPIs) remain prevalent after Roux-en-Y Gastric Bypass (RYGB), despite it being known to alleviate reflux. The physiological changes behind long-term GERD and hiatal hernia (HH) prevalence post-RYGB are not commonly investigated. METHODS In this consecutive cohort study, we examined patients who underwent RYGB and subsequent upper endoscopy, conducted by an expert bariatric endoscopist. The primary focus was on pouch endoscopic retrosflexion to evaluate the antireflux barrier (ARB). We gathered data encompassing patient demographics, anthropometrics, comorbidities, and findings from esophagogastroduodenoscopy (EGD) at the time of surgery and during follow-up EGD. RESULTS Our study included a total of 42 patients, predominantly female (97.5%) and White (100%), with an average age of 53.6±10.6 years and a body mass index (BMI) of 32.9±9.4 kg/m2. In our findings, all EGDs revealed the presence of a HH of varying sizes. The average HH size was 2.07±0.87 cm. The esophagogastric junction (EGJ) flap was also effaced in all patients with the majority (90.4%, 38 patients) classified as Hill grade IV and a smaller proportion (9.6%, 4 patients) as Hill grade III. Notably, PPI usage increased from the time of surgery to the time of EGD (69.0% vs. 42.9%, P=0.06). CONCLUSION This research highlights the high incidence of HH and EGJ flap effacement in patients after RYGB, potentially elucidating the persistence of reflux symptoms, including weakly acidic or alkaline reflux, post-RYGB.
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Affiliation(s)
- Barham K Abu Dayyeh
- Divisions of Gastroenterology and Hepatology
- Division of Gastroenterology and Advanced Endoscopy, Cedars-Sinai Health System, Los Angeles, CA
| | | | | | | | - Rudy Mrad
- Divisions of Gastroenterology and Hepatology
| | | | - Vitor Brunaldi
- Divisions of Gastroenterology and Hepatology
- Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Peristeri DV, Rowdhwal SSS. Persistent Gastroesophageal Reflux Disease After RYGB: What Shall we do Next? Surg Innov 2025; 32:62-71. [PMID: 39406399 DOI: 10.1177/15533506241292707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is considered the weight loss procedure of choice for obese patients with gastroesophageal reflux disease (GORD). The long-term prevalence of GORD after RYGB for obesity is underestimated as many post-RYGB patients can still complain of severe reflux symptoms, refractory to medications. METHODS This is a narrative review using the patient, intervention, comparison, outcome and study strategy. The literature search was undertaken using PubMed, Medline, and Google Scholar databases with the following MeSH terms: Gastroesophageal reflux disease, GORD, Obesity, Gastric bypass, Roux-en-Y gastric bypass, complication, and fundoplication. RESULTS Twelve original papers and case report studies on 57 patients who met the inclusion criteria were suitable for the present review. Reporting styles on successful treatment outcomes were heterogeneous. Treatment options for these patients are limited but include further surgical or endoscopic interventions. Careful follow-up and appropriate management are paramount for this population. CONCLUSION There is significant paucity in the available evidence on managing GORD after RYGB. This narrative review provides a detailed overview of the underlying causes, discusses the various endoscopic and surgical therapy options, and suggests strategies to provide tailored and appropriate therapy for this complex group of patients.
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Ayoub F, Patel KK. Anti-reflux mucosal ablation for refractory gastroesophageal reflux disease after Roux-en-Y gastric bypass. Endoscopy 2024; 56:E37-E38. [PMID: 38194993 PMCID: PMC10776272 DOI: 10.1055/a-2223-0499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Fares Ayoub
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, United States
| | - Kalpesh K. Patel
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, United States
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Nadeem F, Singh A, Karim M, Khan A, Mirza S, Kabir SA. The Impact of Obesity on Reflux Recurrence Following Laparoscopic Anti-reflux Surgery: An Evidence-Based Systematic Review and Meta-Analysis. Cureus 2024; 16:e56981. [PMID: 38665763 PMCID: PMC11045245 DOI: 10.7759/cureus.56981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Gastroesophageal reflux disease (GERD) is frequently seen in the Western population. Laparoscopic anti-reflux surgery (LARS) is effective in managing this condition. Obesity is strongly associated with GERD, and with the rising rate of obesity, there is, therefore, a concurrently increasing frequency of LARS performed. We aim to review the outcomes of LARS in patients with obesity, including the recurrence of GERD symptoms and peri-operative complications. A systematic review and meta-analysis were performed for articles from June 1992 to June 2022. The literature was reviewed for outcomes of LARS in patients with obesity (BMI≥30). Eligibility criteria included specific BMI, study design, type of surgery, and outcomes. The recurrence of symptoms and peri-operative complications were assessed. Thirty-one studies were thoroughly reviewed. Nine studies (five retrospective and four prospective) were selected for meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow, which included 1,499 patients with obesity and 5,521 without. Laparoscopic Nissen fundoplication was the most common procedure performed. The recurrence of symptoms was significantly lower in patients without obesity (p=0.0001). There was no statistically significant difference between patients with and without obesity in peri-operative complications, re-intervention, and early return to theatres. A higher recurrence rate of GERD symptoms post-LARS was reported in patients with obesity. Further research is required to decrease such risks and propose different methods, such as weight loss prior to surgery or Roux-en-Y (R&Y) gastric bypass. Risks and benefits should be considered by clinicians prior to offering LARS to patients with obesity.
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Affiliation(s)
- Faisal Nadeem
- General Surgery/Bariatric Surgery, Walsall Manor Hospital, Walsall, GBR
- Laparoscopic Surgery, Maroof International Hospital, Islamabad, PAK
| | - Ananya Singh
- General Surgery, Walsall Manor Hospital, Walsall, GBR
| | | | - Amir Khan
- General Surgery/Bariatric Surgery, Walsall Manor Hospital, Walsall, GBR
| | - Salman Mirza
- Bariatric Surgery, Walsall Manor Hospital, Walsall, GBR
| | - Syed A Kabir
- General Surgery/Bariatric Surgery, Walsall Manor Hospital, Walsall, GBR
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Bharani T, Tavakkoli A, Tsai T, Spector D, Tatarian T, Robinson M, Sheu EG. National trends in utilization and safety of gastric bypass, sleeve gastrectomy and conversion surgery in patients with GERD. Surg Endosc 2024; 38:1249-1256. [PMID: 38097748 DOI: 10.1007/s00464-023-10622-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/29/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND While some studies have reported improvement in gastro-esophageal reflux disease (GERD) symptoms after sleeve gastrectomy (SG), others have reported higher incidence of de-novo GERD, worsening of prior GERD symptoms and erosive esophagitis post SG. Furthermore, GERD unresponsive to medical management is one of the most common indications for conversion of SG to Roux-en-Y gastric bypass (RYGB). Real-world data on safety of primary SG, primary RYGB and SG to RYGB conversion for obese patients with GERD would be helpful for informing surgeons and patient procedure selection. We sought to evaluate the trends in utilization and safety of primary RYGB and primary SG for patients with GERD requiring medications, and compare the peri-operative outcomes between primary RYGB and conversion surgery from SG to RYGB for GERD using the MBSAQIP database. METHODS A comparative analysis of post-operative outcomes within 30 days was performed for primary RYGB and primary SG after 1:1 nearest neighbor propensity score matching for patient demographics and preoperative comorbidities using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry from 2015 to 2021. This was followed by comparison of peri-operative outcomes between conversion surgery from SG to RYGB for GERD and primary RYGB using MBSAQIP 2020-2021 data. RESULTS Utilization of primary RYGB increased from 38% in 2015 to 45% in 2021, while primary SG decreased from 62% in 2015 to 55% in 2021 for bariatric patients with GERD. Post-operative outcomes including reoperation, reintervention, readmission, major complications, and death within 30 days were significantly higher for patients undergoing primary RYGB compared to primary SG. Increased readmissions and ED visits were seen with conversion surgery. However, there was no difference in rates of reoperation, reintervention, major complications, or death between primary RYGB and SG conversion to RYGB cohorts. CONCLUSIONS This data suggests that a strategy of performing a primary SG and subsequent SG-RYGB conversion for those with recalcitrant GERD symptoms is not riskier than a primary RYGB. Thus, it may be reasonable to perform SG in patients who are well informed of the risk of worsening GERD requiring additional surgical interventions. However, the impact of such staged approach (SG followed by conversion to RYGB) on long-term outcomes remains unknown.
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Affiliation(s)
- Tina Bharani
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA.
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA.
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Thomas Tsai
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - David Spector
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Talar Tatarian
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Malcolm Robinson
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Eric G Sheu
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
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Monrabal Lezama M, Bras Harriott C, Herbella FAM, Schlottmann F. Gastroesophageal Reflux Disease After Roux-en-Y Gastric Bypass: Pathophysiology and Management. J Laparoendosc Adv Surg Tech A 2024; 34:167-172. [PMID: 38153398 DOI: 10.1089/lap.2023.0289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Introduction: Patients with obesity are often affected by gastroesophageal reflux disease (GERD). Roux-en-Y gastric bypass (RYGB) is considered the ideal operation for patients with severe obesity and GERD. Although the majority of patients improve their reflux with the operation, some might persist symptomatic and others can even develop de novo GERD. The aim of this study was to determine pathophysiologic factors involved in the development of GERD after RYGB surgery and define potential treatments for this condition. Materials and Methods: Studies including patients with GERD before and after RYGB and/or analyzing possible GERD therapies were analyzed by the authors. Searches were conducted in PubMed, Cochrane Library, and Embase databases. Results: GERD can persist, worsen, or develop after RYGB. There are certain technical elements of the operation identified as potential risk factors for GERD. Medical therapy is effective in the majority of patients. Both endoscopic and surgical procedures can also help resolving GERD after RYGB. Conclusions: Although the majority of patients with GERD after RYGB can be effectively managed with medical therapy, some may require endoscopic or surgical treatment. Critical technical elements of RYGB should be considered to reduce the risk of postoperative GERD.
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Affiliation(s)
| | | | - Fernando A M Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
- Department of Surgery, University of Illinois, Chicago, Illinois, USA
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Mills H, Alhindi Y, Idris I, Al-Khyatt W. Outcomes of Concurrent Hiatus Hernia Repair with Different Bariatric Surgery Procedures: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:3755-3766. [PMID: 37917388 PMCID: PMC10687114 DOI: 10.1007/s11695-023-06914-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Hiatus hernia (HH) is prevalent among patients with obesity. Concurrent repair is often performed during metabolic and bariatric surgery (MBS), but a consensus on the safety and effectiveness of concurrent HH repair (HHR) and MBS remains unclear. We performed a systematic review of the safety and effectiveness of concurrent HHR and MBS through the measurement of multiple postoperative outcomes. METHOD Seventeen studies relating to concurrent MBS and HHR were identified. MBS procedures included laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (LRYGB), and adjustable gastric banding (LAGB). Studies with pre- and postoperative measurements and outcomes were extracted. RESULTS For LSG, 9 of 11 studies concluded concurrent procedures to be safe and effective with no increase in mortality. Reoperation and readmission rates however were increased with HHR, whilst GORD rates were seen to improve, therefore providing a solution to the predominant issue with LSG. For LRYGB, in all 5 studies, concurrent procedures were concluded to be safe and effective, with no increase in mortality, length of stay, readmission and reoperation rates. Higher complication rates were observed compared to LSG with HHR. Among LAGB studies, all 4 studies were concluded to be safe and effective with no adverse outcomes on mortality and length of stay. GORD rates were seen to decrease, and reoperation rates from pouch dilatation and gastric prolapse were observed to significantly decrease. CONCLUSION Concurrent HHR with MBS appears to be safe and effective. Assessment of MBS warrants the consideration of concurrent HHR depending on specific patient case and the surgeon's preference.
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Affiliation(s)
- Henry Mills
- Medical School University of Nottingham, Nottingham, UK
| | - Yousef Alhindi
- Clinical, Metabolic and Molecular Physiology Research Group, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3NE, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
- Division of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Iskandar Idris
- Clinical, Metabolic and Molecular Physiology Research Group, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3NE, UK.
- East Midlands Bariatric & Metabolic Institute, Royal Derby Hospital, Derby, DE22 3NE, UK.
| | - Waleed Al-Khyatt
- Medical School University of Nottingham, Nottingham, UK.
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK.
- Bariatric & Metabolic Surgery Department of Excellence, Health Point Hospital, A Mubadala Health Partner, Zayed Sports City, United Arab Emirates.
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Colvin JS, Jalilvand AD, Um P, Noria SF, Needleman BJ, O'Neill SM, Perry KA. Mid-term Outcomes of Nissen Fundoplication Versus Roux-en-y Gastric Bypass for Primary Management of Gastroesophageal Reflux Disease in Patients With Obesity. Surg Laparosc Endosc Percutan Tech 2023; 33:627-631. [PMID: 37671561 DOI: 10.1097/sle.0000000000001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/18/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION The efficacy and outcomes of laparoscopic Nissen fundoplication (LNF) in patients with obesity is controversial. Specifically, concerns regarding long-term outcomes and recurrence in the setting of obesity has led to interest in laparoscopic Roux-en-Y gastric bypass (RYGB). METHODS In this retrospective cohort study, we studied patients with obesity who underwent either LNF or RYGB for gastroesophageal reflux disease. Baseline demographics, clinical variables, operative outcomes, and symptom severity scores were compared. RESULTS Baseline demographics, operative outcomes, and quality-of-life scores were similar. Proton pump inhibitor usage, quality-of-life, symptom severity scores, and satisfaction with the operation were similar between groups at mid-term follow-up. DISCUSSION RYGB and LNF produced similar improvements in disease-specific quality of life with similar rates of complications, side effects, and need for reoperation. This demonstrates that RYGB and LNF represent possible options for surgical management of gastroesophageal reflux disease in obese patients.
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Affiliation(s)
| | | | - Phoebe Um
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sabrena F Noria
- Department of Surgery, The Ohio State University Wexner Medical Center
| | | | - Sean M O'Neill
- Division of Minimally Invasive Surgery, University of Michigan, Ann Arbor, MI
| | - Kyle A Perry
- Department of Surgery, The Ohio State University Wexner Medical Center
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Jazi AHD, Mahjoubi M, Shahabi S, Alqahtani AR, Haddad A, Pazouki A, Prasad A, Safadi BY, Chiappetta S, Taskin HE, Billy HT, Kasama K, Mahawar K, Gawdat K, Rheinwalt KP, Miller KA, Kow L, Neto MG, Yang W, Palermo M, Ghanem OM, Lainas P, Peterli R, Kassir R, Puy RV, Da Silva Ribeiro RJ, Verboonen S, Pintar T, Shabbir A, Musella M, Kermansaravi M. Bariatric Evaluation Through AI: a Survey of Expert Opinions Versus ChatGPT-4 (BETA-SEOV). Obes Surg 2023; 33:3971-3980. [PMID: 37889368 DOI: 10.1007/s11695-023-06903-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Recent advancements in artificial intelligence, such as OpenAI's ChatGPT-4, are revolutionizing various sectors, including healthcare. This study investigates the use of ChatGPT-4 in identifying suitable candidates for bariatric surgery and providing surgical recommendations to improve decision-making in obesity treatment amid the global obesity epidemic. METHODS We devised ten patient scenarios, thoughtfully encompassing a spectrum that spans from uncomplicated cases to more complex ones. Our objective was to delve into the decision-making process regarding the recommendation of bariatric surgery. From July 29th to August 10th, 2023, we conducted a voluntary online survey involving thirty prominent bariatric surgeons, ensuring that there was no predetermined bias in the selection of a specific type of bariatric surgery. This survey was designed to collect their insights on these scenarios and gain a deeper understanding of their professional experience and background in the field of bariatric surgery. Additionally, we consulted ChatGPT-4 in two separate conversations to evaluate its alignment with expert opinions on bariatric surgery options. RESULTS In 40% of the scenarios, disparities were identified between the two conversations with ChatGPT-4. It matched expert opinions in 30% of cases. Differences were noted in cases like gastrointestinal metaplasia and gastric adenocarcinoma, but there was alignment with conditions like endometriosis and GERD. CONCLUSION The evaluation of ChatGPT-4's role in determining bariatric surgery suitability uncovered both potential and shortcomings. Its alignment with experts was inconsistent, and it often overlooked key factors, emphasizing human expertise's value. Its current use requires caution, and further refinement is needed for clinical application.
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Affiliation(s)
- Amir Hossein Davarpanah Jazi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Niyaesh Avenue, Sattar Khan Street, Tehran, Iran
| | - Mohammad Mahjoubi
- Clinical Research Development Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Shahab Shahabi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Niyaesh Avenue, Sattar Khan Street, Tehran, Iran.
| | | | - Ashraf Haddad
- Gastrointestinal Metabolic and Bariatric Center, GBMC M, Jordan Hospital, Amman, Jordan
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Niyaesh Avenue, Sattar Khan Street, Tehran, Iran
| | - Arun Prasad
- GI, Bariatric and Robotic Surgery Apollo Hospital, New Delhi, India
| | | | - Sonja Chiappetta
- Bariatric and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Halit Eren Taskin
- Department of General Surgery, Cerrahpaşa Medical Faculty, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | | | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | | | - Khaled Gawdat
- Ain Shams University Faculty of Medicine Department of General Surgery, Cairo, Egypt
| | - Karl Peter Rheinwalt
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus Hospital, Cologne, Germany
| | | | - Lilian Kow
- Department GI Surgery Flinders, University South Australia, Adelaide, Australia
| | | | - Wah Yang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Mariano Palermo
- Gastrointestinal and Bariatric Surgery, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Panagiotis Lainas
- Department of Digestive and Bariatric Surgery, Metropolitan Hospital, HEAL Academy, Athens, Greece
| | - Ralph Peterli
- Deputy Head of Visceral Surgery and Head of Bariatric-Metabolic Surgery Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | - Radwan Kassir
- Digestive Surgery Unit, University Hospital of La Réunion -Félix Guyon Hospital, Saint-Denis, La Réunion, France
| | - Ramon Vilallonga Puy
- Head Endocrine-Metabolic and Bariatric Surgery Unit, Vall Hebron Barcelona Hospital Campus, Pg. De La Vall d'hebron, 119-129, 08035, Barcelona, Spain
| | - Rui José Da Silva Ribeiro
- General Surgery Department, Multidisciplinary Center for Obesity Treatment - Hospital Lusíadas Amadora, Amadora, Portugal
| | | | - Tadeja Pintar
- UMC Ljubljana, Department of Abdominal Surgery and Medical Faculty, Ljubljana, Slovenia
| | - Asim Shabbir
- National University of Singapore, Singapore, Singapore
| | - Mario Musella
- Advanced Biomedical Sciences Department, "Federico II" University, Naples, Italy
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Niyaesh Avenue, Sattar Khan Street, Tehran, Iran
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12
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Ibele AR, Nau PN, Galvani C, Roth JS, Goldberg RF, Kurian MS, Khaitan L, Gould J, Pandya YK. Surgeon experience with insurance barriers to offering gastric bypass as an evidence-based operation for pathologic GERD. Surg Endosc 2023; 37:7642-7648. [PMID: 37491660 DOI: 10.1007/s00464-023-10212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/11/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Obesity is an increasingly prevalent public health problem often associated with poorly controlled gastroesophageal reflux disease. Fundoplication has been shown to have limited long-term efficacy in patients with morbid obesity and does not address additional weight-related co-morbidities. Roux-en-Y gastric bypass (RYGB) is the gold standard operation for durable resolution of GERD in patients with obesity, and is also used as a salvage operation for GERD after prior foregut surgery. Surgeons report access to RYGB as surgical treatment for GERD is often limited by RYGB-specific benefit exclusions embedded within insurance policies, but the magnitude and scope of this problem is unknown. METHODS A 9-item survey evaluating surgeon practice and experience with insurance coverage for RYGB for GERD was developed and piloted by a SAGES Foregut Taskforce working group. This survey was then administered to surgeon members of the SAGES Foregut Taskforce and to surgeons participating in the SAGES Bariatrics and/or Foregut Facebook groups. RESULTS 187 surgeons completed the survey. 89% reported using the RYGB as an anti-reflux procedure. 44% and 26% used a BMI of 35 kg/m2 and 30 kg/m2 respectively as cutoff for the RYGB. 89% viewed RYGB as the procedure of choice for GERD after bariatric surgery. 69% reported using RYGB to address recurrent reflux secondary to failed fundoplication. 74% of responders experienced trouble with insurance coverage at least half the time RYGB was offered for GERD, and 8% reported they were never able to get approval for RYGB for GERD indications in their patient populations. CONCLUSION For many patients, GERD and obesity are related diseases that are best addressed with RYGB. However, insurance coverage for RYGB for GERD is often limited by policies which run contrary to evidence-based medicine. Advocacy is critical to improve access to appropriate surgical care for GERD in patients with obesity.
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Affiliation(s)
- Anna R Ibele
- Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City Utah, 84132, USA.
| | - Peter N Nau
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Carlos Galvani
- Tulane University School of Medicine, New Orleans, LA, USA
| | - J Scott Roth
- University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Leena Khaitan
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jon Gould
- Medical College of Wisconsin, Milwaukee, WI, USA
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13
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Balagué C, Nve E, Puértolas N, Rodriguez J. Anti-reflux surgery vs. bariatric surgery as anti-GERD and hiatal hernia treatment in obese patient. New surgical proposals. Cir Esp 2023; 101 Suppl 4:S19-S25. [PMID: 37979937 DOI: 10.1016/j.cireng.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/13/2023] [Indexed: 11/20/2023]
Abstract
The persistence of obesity favors the failure of the Fundoplication (FP) in the treatment of Gastroesophageal Reflux (GER). However, the weight loss obtained with the performance of a Gastric Bypass (GBP) allows a good resolution of symptoms, without increasing the incidence of postoperative complications. All of this leads us to consider that while FP is the indication in patients with BMI < 30, in those patients with BMI > 35, GBP appears to be the procedure of choice. But there is still no position in the case of patients with a BMI between 30 and 35, although we must take into account that an increase in GER recurrence has been described after FP in patients with a BMI > 30. Although Sleeve Gastrectomy (SG) is one of the most frequently used bariatric procedures in recent years, its association with a high rate of postoperative GER has led several authors to propose its performance associated with an anti-reflux procedure in patients with GER symptoms. Likewise, if the existence of an Hiatal Hernia is verified, it must be treated by hiatoplasty, both during the performance of a GBP and a SG. This simultaneous treatment is not associated with an increase in complications.
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Affiliation(s)
- Carmen Balagué
- Unidad de Cirugía Esofagogástrica, Bariátrica y Metabólica, Servicio de Cirugía General, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain.
| | - Esther Nve
- Unidad de Cirugía Esofagogástrica, Bariátrica y Metabólica, Servicio de Cirugía General, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
| | - Noelia Puértolas
- Unidad de Cirugía Esofagogástrica, Bariátrica y Metabólica, Servicio de Cirugía General, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
| | - Joaquín Rodriguez
- Unidad de Cirugía Esofagogástrica, Bariátrica y Metabólica, Servicio de Cirugía General, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
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14
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Masood M, Low D, Deal SB, Kozarek RA. Gastroesophageal Reflux Disease in Obesity: Bariatric Surgery as Both the Cause and the Cure in the Morbidly Obese Population. J Clin Med 2023; 12:5543. [PMID: 37685616 PMCID: PMC10488124 DOI: 10.3390/jcm12175543] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
Gastrointestinal reflux disease (GERD) is a chronic, highly prevalent condition in the United States. GERD can significantly impact quality of life and lead to complications including aspiration pneumonia, esophageal stricture, Barrett's esophagus (BE) and esophageal cancer. Obesity is a risk factor for GERD, which often improves with weight loss and bariatric surgery. Though the incidence of bariatric surgery, in particular, minimally invasive sleeve gastrectomy, has risen in recent years, emerging data has revealed that the severity or new onset of GERD may follow bariatric surgery. We performed a literature review to provide a detailed analysis of GERD with an emphasis on bariatric surgery as both the cure and the cause for GERD in the morbidly obese population. We also describe the pathophysiological mechanisms, management approach and treatment strategies of GERD following bariatric surgery.
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Affiliation(s)
- Muaaz Masood
- Division of Gastroenterology and Hepatology, Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA 98101, USA
| | - Donald Low
- Division of Thoracic Surgery, Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA 98101, USA
| | - Shanley B. Deal
- Division of General Surgery, Center for Weight Management, Virginia Mason Franciscan Health, Seattle, WA 98101, USA
| | - Richard A. Kozarek
- Division of Gastroenterology and Hepatology, Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA 98101, USA
- Center for Interventional Immunology, Benaroya Research Institute, Virginia Mason Franciscan Health, Seattle, WA 98101, USA
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15
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Ghanem OM, Ghazi R, Abdul Razzak F, Bazerbachi F, Ravi K, Khaitan L, Kothari SN, Abu Dayyeh BK. Turnkey algorithmic approach for the evaluation of gastroesophageal reflux disease after bariatric surgery. Gastroenterol Rep (Oxf) 2023; 11:goad028. [PMID: 37304555 PMCID: PMC10256627 DOI: 10.1093/gastro/goad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/12/2022] [Accepted: 02/01/2023] [Indexed: 06/13/2023] Open
Abstract
Bariatric surgeries are often complicated by de-novo gastroesophageal reflux disease (GERD) or worsening of pre-existing GERD. The growing rates of obesity and bariatric surgeries worldwide are paralleled by an increase in the number of patients requiring post-surgical GERD evaluation. However, there is currently no standardized approach for the assessment of GERD in these patients. In this review, we delineate the relationship between GERD and the most common bariatric surgeries: sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), with a focus on pathophysiology, objective assessment, and underlying anatomical and motility disturbances. We suggest a stepwise algorithm to help diagnose GERD after SG and RYGB, determine the underlying cause, and guide the management and treatment.
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Affiliation(s)
- Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rabih Ghazi
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, MN, USA
| | - Karthik Ravi
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Leena Khaitan
- Department of Surgery, Case Western Reserve University, Cleveland, OH, USA
| | | | - Barham K Abu Dayyeh
- Corresponding author. Division of Gastroenterology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel: +1-507-284-2511; Fax: +1-507-284-0538;
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16
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Strong AT, Aleassa EM, Feng X, Aminian A, Gutnick J, McMichael J, Augustin T. Use of Acid Suppressive Therapy Following Gastric Bypass and Sleeve Gastrectomy at Long-Term Follow-Up. Bariatr Surg Pract Patient Care 2023; 18:66-71. [DOI: 10.1089/bari.2021.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025] Open
Affiliation(s)
- Andrew T. Strong
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Essa M. Aleassa
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Xiaoxi Feng
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ali Aminian
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Jesse Gutnick
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John McMichael
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Toms Augustin
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
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17
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Ngo F, Urman RD, English W, Kothari S, DeMaria E, Wadhwa A. An analysis of enhanced recovery pathways for bariatric surgery-preoperative fasting, carbohydrate loading, and aspiration risk: a position statement from the International Society for the Perioperative Care of Patients with Obesity. Surg Obes Relat Dis 2023; 19:171-177. [PMID: 36732143 DOI: 10.1016/j.soard.2022.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/10/2022] [Indexed: 01/06/2023]
Abstract
Enhanced recovery pathways (ERPs) and recommendations have become widely accepted for metabolic and bariatric surgery, including recommendations for preoperative carbohydrate loading and duration of fasting status. There is still a lack of consensus regarding such protocols and the underlying issues of gastric emptying time, resting gastric volume and pH, and risk of aspiration in patients with severe obesity and in patients undergoing bariatric surgery. The goal of this position statement by the International Society for the Perioperative Care of Patients with Obesity (ISPCOP) is to provide an analysis of available data on preoperative fasting and loading with oral complex clear carbohydrate drinks as well its potential effects on perioperative risk of aspiration in the context of Enhanced Recovery Pathways for Metabolic and Bariatric Surgery (ERAMBS).
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Affiliation(s)
- Fallon Ngo
- Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Richard D Urman
- International Society of Perioperative Care of Patients with Obesity, Lynnwood, Washington; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Wayne English
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shanu Kothari
- Department of Surgery, University of South Carolina Greenville, Prisma Health - Greenville Memorial Medical Campus, Greenville, South Carolina.
| | - Eric DeMaria
- Department of Surgery, East Carolina University, Greenville, North Carolina
| | - Anupama Wadhwa
- Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center, Dallas, Texas; International Society of Perioperative Care of Patients with Obesity, Lynnwood, Washington; Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio
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18
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Balagué C, Nve E, Puértolas N, Rodriguez J. Cirugía antirreflujo vs cirugía bariátrica como tratamiento anti-RGE y de la hernia de hiato en el obeso. Nuevas propuestas quirúrgicas. Cir Esp 2023. [DOI: 10.1016/j.ciresp.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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19
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Lee MH, Almalki OM, Lee WJ, Soong TC, Chen SC. Outcomes of laparoscopic revisional conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: Diff erent strategies for obese and non-obese Asian patients. Asian J Surg 2023; 46:761-766. [PMID: 35843822 DOI: 10.1016/j.asjsur.2022.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 05/05/2022] [Accepted: 07/06/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Sleeve gastrectomy (SG) is the most performed bariatric procedure now. Some patients would necessitate a revision to Roux-en-Y gastric bypass (RYGB) as a salvage procedure for intractable gastroesophageal reflux disease (GERD). However, outcome of the revision in Asians with co-existed obesity and those non-obese is not clear. METHODS We retrospectively reviewed the data of patients who underwent revisional laparoscopic RYGB after SG between 2007 and 2019 for intractable GERD with data of one year follow-up. Pre-operative clinical data, perioperative outcomes, GERD symptoms, weight loss and medication details were analyzed. Patients were classified into those with body mass index (BMI) ≥ 25 and < 25 kg/m2. RESULTS Fifty-five patients (44 women, 11 men; mean age 42.5 years) were included. Mean interval from the initial SG to revision surgery was 51.2 months (range, 5-132). Mean body mass index before SG was 34.6 kg/m2, whereas that before revision surgery was 27.6 kg/m2. All the patients required continue proton pump inhibitor (PPI) to control the GERD symptoms before surgery. Among them, 36 (65.4%) patients in the obese group received long BP limb (>100 cm) RYGB for associated obesity but the common channel was assured to ≥ 400 cm or 70% of small bowel length, the other 19 (34.6%) patients in the non-obese group received standard BP limb (<100 cm) RYGB. There was no difference in basic characters between the two groups before revision surgery except a higher mean BMI (30.0 vs. 22.2 kg/m2, p < 0.001), blood pressure and triglyceride in obese group. One year after revision surgery, all the patients had improved GERD symptoms but only 33 (60%) can completely wave PPI, without difference between the 2 groups. Obese group with a long BP limb RYGB had a significant higher % total weight loss (TWL) than non-obese group (%TWL 9.1% vs. -3.1%, p = 0.005). CONCLUSION Laparoscopic revision to RYGB is a safe and effective treatment for patients with intractable GERD after SG but some patients may still have residual GERD symptoms. Using a modified RYGB technique in revision surgery may help in weight reduction for obese Asian patients.
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Affiliation(s)
- Ming-Hsien Lee
- Metabolic & Bariatric Surgical Department, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan, ROC
| | - Owaid M Almalki
- Department of Surgery, College of Medicine, Taif University, Saudi Arabia
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan, ROC; Department of Asia Obesity Medical Research Center, E-DA Hospital, Taiwan, ROC.
| | - Tien-Chou Soong
- Department of Asia Obesity Medical Research Center, E-DA Hospital, Taiwan, ROC; Department of Weight Loss and Health Management Center, E-DA Dachang Hospital, Kaohsiung, Taiwan, ROC; College of Medicine, I-Shou University, Kaohsiung, Taiwan, ROC
| | - Shu-Chun Chen
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan, ROC
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20
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Petchers A, Walker A, Bertram C, Feustel P, Singh TP, Zaman J. Evaluation of endoscopic gastrojejunostomy revision after Roux-en-Y gastric bypass for treatment of dumping syndrome. Gastrointest Endosc 2022; 96:639-644. [PMID: 35500660 DOI: 10.1016/j.gie.2022.04.1306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/21/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Gastrojejunostomy stomal dilation is a frequent cause of weight regain after Roux-en-Y gastric bypass and may be a contributing cause of dumping syndrome. This study aims to evaluate the long-term durability of endoscopic gastrojejunostomy revision (EGJR) to resolve dumping syndrome. METHODS A retrospective chart review was performed of patients undergoing EGJR at a single institution from January 1, 2013 to December 1, 2018. The primary endpoint, dumping symptom resolution, was measured at 1 month and at the most recent postoperative follow-up. Continuous data are reported as mean and standard deviations and categorical data as percentages. The Fisher exact test was used to assess associations between categorical variables. RESULTS Ninety-eight patients underwent EGJR for dumping syndrome. Mean patient age was 51 years (standard deviation [SD], 9.9), and mean body mass index (BMI) was 36.2 kg/m2 (SD, 7.1), with most patients (53%) presenting with BMIs ≥35 kg/m2. Thirty-two patients (32%) reported severe dumping (≥3 symptoms). All patients were followed-up for 1 month, and 83% had a long-term follow-up at a mean of 3.45 years (SD, 1.7) after EGJR. In addition, 88% had initial symptom resolution at 1 month, and 85% reported symptom resolution 3 years postoperatively. Patients with GERD had a statistically significant improvement in dumping syndrome at 3 years compared with those without GERD (69% vs 62%, P = .03). Long-term weight loss averaged 2.1 pounds after EGJR. CONCLUSIONS EGJR is associated with effective and durable resolution of dumping syndrome at 3 years postoperatively, with a minimal long-term impact on weight loss. The presence of GERD preoperatively correlates with a statistically significant resolution of dumping syndrome.
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Affiliation(s)
- Adam Petchers
- Department of Surgery, Albany Medical Center, Albany, New York, USA
| | | | | | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, New York, USA
| | - T Paul Singh
- Department of Surgery, Albany Medical Center, Albany, New York, USA
| | - Jessica Zaman
- Department of Surgery, Albany Medical Center, Albany, New York, USA
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21
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Indja B, Chan DL, Talbot ML. Hiatal reconstruction is safe and effective for control of reflux after laparoscopic sleeve gastrectomy. BMC Surg 2022; 22:347. [PMID: 36131312 PMCID: PMC9490990 DOI: 10.1186/s12893-022-01800-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Gastroesophageal reflux is a known complication following laparoscopic sleeve gastrectomy (LSG) as anatomical changes predispose to reduced lower esophageal sphincter pressure and development of hiatus hernia. The mainstay of surgical management has been Roux-en-Y gastric bypass (RYGB) which is not without risk. Hiatus hernia repair (HHR) with surgical reattachment of the oesophagus to the crura, recreating the phreno-esophageal ligament is a simple procedure specifically targeting a number of anatomical changes responsible for reflux in this population. Methods We conducted a single centre retrospective analysis of adult patients with post-sleeve reflux refractory to medical treatment, managed with either HHR, RYGB or One-anastomosis Duodenal switch (OADS). PPI use and symptoms of reflux were assessed at early and mid-term time points via validated questionnaires.
Results 99 patients were included, of these the surgical procedure was HHR alone in 58, RYGB in 29 and OADS in 12. At early follow-up control of reflux symptoms was achieved in 72.4% after HHR, 82.1% after RYGB and 100% after OADS with no significant difference between groups (p = 0.09). At mid-term followup (median 10 months IQR 7–21) there was no significant difference in the presence of symptomatic reflux as determined by post-op Visick score nor a difference in PPI use. The GerdQ score was significantly lower after OADS as compared to HHR and RYGB (4.6 ± 2.3 vs 7.7 ± 2.2 vs 8.7 ± 3.5, p = 0.006). Conclusion HHR with reconstruction of the phreno-esophageal ligament is a safe and effective procedure for patients with reflux after LSG, that avoids more complex operations such as RYGB and OADS and their associated long-term sequelae.
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Affiliation(s)
- Ben Indja
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. .,Department of Surgery, St George Hospital, Sydney, NSW, Australia. .,Upper GI Surgery, St George Private Hospital, Suite 3, Level 5, 1 South, Sydney, NSW, 2217, Australia.
| | - Daniel L Chan
- Department of Surgery, St George Hospital, Sydney, NSW, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Michael L Talbot
- Department of Surgery, St George Hospital, Sydney, NSW, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia.,Upper GI Surgery, St George Private Hospital, Suite 3, Level 5, 1 South, Sydney, NSW, 2217, Australia
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22
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Snyder DL, Katzka DA. Complex Gastroesophageal Reflux Disease. GASTRO HEP ADVANCES 2022; 1:420-430. [PMID: 39131678 PMCID: PMC11307939 DOI: 10.1016/j.gastha.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/15/2022] [Indexed: 08/13/2024]
Abstract
Gastroesophageal reflux disease (GERD) is the most prevalent gastrointestinal disorder posing diagnostic and therapeutic challenges. Diagnosis should be objectively defined with endoscopy and pH testing, while novel metrics may augment diagnosis for inconclusive GERD cases, including the postreflux swallow-induced peristaltic wave index and esophageal mucosal impedance. Conditions that overlap with or mimic GERD should be considered such as achalasia, rumination, and eosinophilic esophagitis. Genetic testing for proton pump inhibitor metabolism is an option for precision therapy in complex persistent GERD. Proton pump inhibitor refractory GERD may require medical, surgical, or endoscopic therapies. The presence of GERD should be objectively evaluated in achalasia patients treated with peroral endoscopic myotomy, and further studies are needed to determine timing of this evaluation. Patients with scleroderma are at a high risk for GERD owing to abnormal esophageal motility and should be managed with aggressive medical therapy and lifestyle changes given the high prevalence of esophagitis and Barrett's esophagus in this population. Further studies are needed to understand the complex mechanisms of GERD in idiopathic pulmonary fibrosis and lung transplantation.
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23
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DuCoin C, Wasselle J, Kayastha A, Zuercher H, Wilensky A, Sujka J, Mhaskar R, Kuo P, Velanovich V. Massive Paraesophageal Hernia Repair in the Obese Patient Population: Antireflux Gastric Bypass Versus Fundoplication. J Laparoendosc Adv Surg Tech A 2022; 32:1038-1042. [PMID: 35333616 DOI: 10.1089/lap.2022.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction: Obesity is a risk factor for gastroesophageal reflux disease (GERD) and hiatal hernia (HH). Fundoplication is the standard operation for GERD with HH. Roux-en-Y gastric bypass (RYGB) is the procedure of choice for obese patients with either GERD or a large HH, but neither are indications for RYGB. To delineate bypass surgery as a treatment option for obese patients with HH and GERD, we propose new terminology, antireflux gastric bypass (ARGB). ARGB differs from RYGB by utilizing varying efferent limb lengths for GERD treatment. We hypothesized that ARGB would have higher GERD resolution, lower HH recurrence, and improves weight loss when compared with fundoplication. Methods: A retrospective cohort study was performed, evaluating patients undergoing repair of large HH (>5 cm) with obesity from January 2013 to February 2021. The primary outcome was GERD resolution, secondary outcomes include HH recurrence and weight loss. Multivariate logistic regression adjusted for age, body mass index (BMI), and hernia size by nonlinear mixed modeling. Results: Forty patients underwent fundoplication, and 16 patients underwent ARGB. Fundoplication patients had a larger mean hernia size (8.7 × 6.3 cm versus 6.6 × 6.4 cm), whereas ARGB patients had a higher BMI (39.2 versus 34.2 kg/m2). Recurrence showed nonstatistically significant lower incidence with ARGB and no significant difference in GERD resolution. Weight (P < .0001) and excess body weight (P < .0001) loss were superior with ARGB. Conclusions: Obese patients with large HHs and GERD treated with ARGB had similar GERD resolution, lower HH recurrence, and improved weight loss when compared with fundoplication. ARGB is an acceptable treatment option for obese patients with a massive paraesophageal hernia in the setting of GERD.
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Affiliation(s)
- Christopher DuCoin
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Joseph Wasselle
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Ahan Kayastha
- University of South Florida Health Morsani College of Medicine, Tampa, Florida, USA
| | - Hannah Zuercher
- University of South Florida Health Morsani College of Medicine, Tampa, Florida, USA
| | - Adam Wilensky
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Joseph Sujka
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Paul Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Vic Velanovich
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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24
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Motola D, Zeini IM, Moon RC, Ghanem M, Teixeira AF, Jawad MA. ANTI-REFLUX PROCEDURES AFTER ROUX-EN-Y GASTRIC BYPASS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2022; 34:e1614. [PMID: 35019126 PMCID: PMC8735260 DOI: 10.1590/0102-672020210002e1614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/20/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) has been the choice of bariatric procedure for patients with symptomatic reflux - and is known to be effective in reducing the need for anti-reflux medication postoperatively. However, a small number of RYGB patients can still develop severe reflux symptoms that require a surgical intervention. AIM To examine and describe the patient population that requires an anti-reflux procedure after RYGB evaluating demographics, characteristics, symptoms and diagnosis. METHODS A retrospective chart review was performed on 32 patients who underwent a hiatal hernia repair and/or Nissen fundoplication after RYGB Jul 1st, 2014 and Dec 31st, 2019. Patients were identified using the MBSAQIP database and their electronic medical records were reviewed. RESULTS Most patients were female (n=29, 90.6%). The mean age was 52.8 years and the mean body mass index (BMI) was 34.1 kg/m2 at the time of anti-reflux procedure. Patients underwent the anti-reflux procedure at a mean of 7.9 years after the RYGB procedure. The mean percentage of excess BMI loss during the time between RYGB and anti-reflux procedure was 63.4%. CONCLUSIONS Female patients with a significant weight loss may develop a severe reflux symptoms years after RYGB. Complaints of reflux after RYGB should not be overlooked. Careful follow-up and appropriate treatment (including surgical intervention) is needed for this population.
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Affiliation(s)
- David Motola
- Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, FL, USA
| | - Ibrahim M Zeini
- Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, FL, USA
| | - Rena C Moon
- Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, FL, USA
| | - Muhammad Ghanem
- Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, FL, USA
| | - Andre F Teixeira
- Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, FL, USA
| | - Muhammad A Jawad
- Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, FL, USA
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25
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BRAGHETTO I, KORN O, GUTIÉRREZ L, TORREALBA A, ROJAS J. GASTROESOPHAGEAL SYMPTOMS AFTER LAPAROSCOPIC GASTRIC BYPASS: MISTAKES IN PERFORMING THE PROCEDURE? ABCD. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA (SÃO PAULO) 2022; 35:e1657. [PMID: 35730886 PMCID: PMC9254385 DOI: 10.1590/0102-672020210002e1657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Abstract
Laparoscopic Roux-en-Y gastric bypass (LGB) is the recommended procedure for
morbidly obese patients with gastroesophageal reflux disease (GERD). However,
there have been reported gastroesophageal reflux symptoms or esophagitis after
LGB. Few functional esophageal studies have been reported to date.
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26
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Medina B, Molena D. Reflux, Barrett's Esophagus, and Esophageal Adenocarcinoma After Bariatric Surgery. FOREGUT (THOUSAND OAKS, CALIF.) 2021; 1:393-400. [PMID: 38646141 PMCID: PMC11031263 DOI: 10.1177/26345161211068367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
We present the case of a patient who developed esophageal adenocarcinoma after a previous laparoscopic sleeve gastrectomy. Bariatric surgery has emerged as the most effective treatment option for weight loss and obesity-related diseases; however, sleeve gastrectomy promotes gastroesophageal reflux and leads to Barrett's esophagus in a substantial portion of patients. The natural history of Barrett's esophagus in these patients is unknown, and active surveillance is recommended until the incidence of dysplasia and adenocarcinoma in this population is clarified. Management options for these patients include conversion to Roux-en-Y gastric bypass. Although esophagectomy in patients who have previously undergone sleeve gastrectomy may require an alternative conduit, the remnant stomach can be used in carefully selected patients. Here, we review the different weight loss procedures, their effect on gastroesophageal reflux disease and Barrett's esophagus, and the treatment options for patients with esophageal cancer after sleeve gastrectomy. We report the use of preoperative coil embolization as a means of vascular preconditioning before successful use of a gastric conduit.
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27
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Abstract
Patients with obesity who present with gastroesophageal reflux disease (GERD) require a nuanced approach. Those with lower body mass index (BMI) (less than 33) can be counseled on weight loss, and if successful may be approached with laparoscopic fundoplication. Those who are unable to achieve weight loss or those who present with a BMI greater than or equal to 35 should proceed with laparoscopic Roux-en-Y gastric bypass (LRYGB). Conversion to LRYGB from sleeve gastrectomy is a safe and effective way to manage GERD after sleeve gastrectomy.
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28
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Musella M, Berardi G, Velotti N, Schiavone V, Vitiello A. Ten-Year Results of Laparoscopic Sleeve Gastrectomy: Retrospective Matched Comparison with Laparoscopic Adjustable Gastric Banding-Is There a Significant Difference in Long Term? Obes Surg 2021; 31:5267-5274. [PMID: 34601648 PMCID: PMC8595233 DOI: 10.1007/s11695-021-05735-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The laparoscopic sleeve gastrectomy (LSG) is the most common bariatric procedure performed worldwide while the laparoscopic adjustable gastric banding (LAGB) has been almost abandoned. Aim of this study was to retrospectively assess 10-year outcomes of LSG through a matched comparison with LAGB. MATERIALS AND METHODS Retrospective search of prospectively maintained database of our university was carried out to find all patients that underwent LSG before December 2010. Each subject with LSG was matched one-to-one with a patient that had undergone LAGB in the same period with correspondent preoperative age, BMI, and sex. RESULTS A total of 76 patients underwent LSG before 2010 and were all included in this study; a matched group of 76 out of 178 LAGB patients with 10-year follow-up was retrieved from our database. Comparison between the two groups showed better outcomes after LSG at 1 and 5 years but weight loss was comparable with the LAGB group at 10 years (%TWL 22.2 ± 13 vs 21.2 ± 16.1; p = 0.89). No significant difference was found in conversion/removal rate (15.8% vs 18.4%; p = 0.67). CONCLUSION LSG is an effective stand-alone bariatric procedure with better outcomes than LAGB in medium term, but results are comparable at 10 years. Subjects undergoing LSG should be informed that conversion to RYGB or OAGB may be necessary to achieve further weight loss or to treat reflux.
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Affiliation(s)
- Mario Musella
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Vincenzo Schiavone
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
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29
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Wei JP, Cui HL. Progress in understanding of influence of bariatric surgery on reflux esophagitis. Shijie Huaren Xiaohua Zazhi 2021; 29:1298-1303. [DOI: 10.11569/wcjd.v29.i22.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In today's society, as the number of obese people increases year by year, the incidence of gastroesophageal reflux disease (GERD) continues to rise. Although bariatric surgery has brought good news to these patients who are unable to lose weight on their own, it is still unclear whether it is effective in relieving GERD, or even inducing or aggravating GERD. In this article, we will review and provide evidence of the effect of bariatric surgery on GERD.
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Affiliation(s)
- Jin-Ping Wei
- Department of General Surgery, Chuiyangliu Hospital Affiliated to Tsinghua University, Beijing 100022, China
| | - Hong-Li Cui
- Department of General Surgery, Chuiyangliu Hospital Affiliated to Tsinghua University, Beijing 100022, China
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30
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Assessment and management of gastroesophageal reflux disease following bariatric surgery. Surg Obes Relat Dis 2021; 17:1919-1925. [PMID: 34620566 DOI: 10.1016/j.soard.2021.07.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 12/12/2022]
Abstract
Gastroesophageal reflux disease (GERD) is a common disease in patients with obesity. The incidence of de novo GERD and the effect of bariatric surgery on patients with pre-existing GERD remain controversial. Management of GERD following bariatric surgery is complicated and can range from medical therapy to non-invasive endoscopic options to invasive surgical options. To address these issues, we performed a systematic review of the literature on the incidence of GERD and the various modalities of managing GERD in patients following bariatric surgery. Given the increased number of laparoscopic sleeve gastrectomy (LSG) procedures being performed and the high incidence of GERD following LSG, bariatric surgeons should be familiar with the options available to manage GERD following LSG as well as other bariatric procedures.
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31
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Thalheimer A, Bueter M. Excess Body Weight and Gastroesophageal Reflux Disease. Visc Med 2021; 37:267-272. [PMID: 34540942 DOI: 10.1159/000516050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background Gastroesophageal reflux disease (GERD) is strongly associated with excess body weight. Summary GERD is characterized by typical symptoms with or without mucosal damage because of retrograde flow of gastric content into the esophagus. An ineffective esophagogastric junction (EGJ) combined with anatomical abnormalities is considered to be causative. The incidence of GERD is strongly associated with excess body weight, reflecting the pathophysiological relevance of the abdominothoracic pressure gradient. Key Message Weight loss has been demonstrated to be an effective therapy for GERD combined with obesity. In cases in which surgical therapy is indicated, traditional antireflux surgery has led to equivocal results, advocating a proximal Roux-en-Y gastric bypass in these patients to correct both GERD and excess body weight.
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Affiliation(s)
- Andreas Thalheimer
- Department of Visceral and Transplant Surgery, University Hospital of Zürich, Zurich, Switzerland.,Department of Surgery, Spital Männedorf, Männedorf, Switzerland
| | - Marco Bueter
- Department of Visceral and Transplant Surgery, University Hospital of Zürich, Zurich, Switzerland.,Department of Surgery, Spital Männedorf, Männedorf, Switzerland
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Abstract
PURPOSE OF REVIEW Obesity is rapidly increasing in prevalence, and bariatric surgery has become a popular treatment option that can improve all-cause mortality in obese individuals. Gastroesophageal reflux disease (GERD) and esophageal motility disorders are common in the obese population, and the effects of bariatric surgery on these conditions differ depending on the type of bariatric surgery performed. RECENT FINDINGS Laparoscopic adjustable gastric banding has declined in popularity due to its contributions to worsening GERD symptoms and the development of esophageal dysmotility. Although laparoscopic sleeve gastrectomy (LSG) is the most popular type of bariatric surgery, a comprehensive assessment for acid reflux should be performed as LSG has been linked with worsening GERD. Novel methods to address GERD due to LSG include magnetic sphincter augmentation and concomitant fundoplication. Due to the decreased incidence of postoperative GERD and dysmotility compared to other types of bariatric surgeries, Roux-en-Y gastric bypass should be considered for obese patients with GERD and esophageal dysmotility. SUMMARY Bariatric surgery can affect esophageal motility and contribute to worsening or development of GERD. A thorough workup of gastrointestinal symptoms before bariatric surgery should be performed with consideration for formal testing with high-resolution manometry and pH testing. Based on these results, the choice of bariatric surgery technique should be tailored accordingly to improve clinical outcomes.
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33
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Aleman R, Lo Menzo E, Szomstein S, Rosenthal RJ. De novo gastroesophageal reflux disease esophageal surgery in bariatrics: a literature review and analysis of the current treatment options. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:899. [PMID: 34164533 PMCID: PMC8184411 DOI: 10.21037/atm-20-5890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
With the exponential increase of worldwide obesity, the number of bariatric surgery (BaS) procedures have equally risen. The surgical management of obesity has been widely established as the standard of care for sustained weight reduction, resolution, and improvement of associated comorbidities. However, BaS itself can have postoperative deleterious effects, including de novo gastroesophageal reflux disease (GERD) and upper gastrointestinal motility disorders. The modified anatomy resulting from BaS, due to either a restrictive or hypoabsorptive component, gives this disorder a multifactorial etiology. The overall management of de novo GERD should focus on three primordial approaches: Non-surgical, endoluminal, and surgical. Even in the absence of de novo GERD following primary or secondary BaS, said disorder should be closely monitored and therapy should be catered in a case-by-case approach. Consequently, treatment strategies have been developed on this principle as to adequately resolve de novo GERD. Despite the presence of multiple and suitable treatment modalities, the operating surgeon should perform them in the best interest of the patient. Short-, medium-, and long-term outcomes should be taken into consideration prior to proceed with any type of preferred management option. This article herein presents an update on the surgical management of de novo GERD following BaS and current practical innovations.
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Affiliation(s)
- Rene Aleman
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA
| | - Emanuele Lo Menzo
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA
| | - Samuel Szomstein
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA
| | - Raul J Rosenthal
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA
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34
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Jaruvongvanich V, Osman K, Matar R, Baroud S, Hanada Y, Chesta FNU, Maselli DB, Mahmoud T, Wang KK, Abu Dayyeh BK. Impact of bariatric surgery on surveillance and treatment outcomes of Barrett's esophagus: A stage-matched cohort study. Surg Obes Relat Dis 2021; 17:1457-1464. [PMID: 34083137 DOI: 10.1016/j.soard.2021.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/19/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity could increase the risk of Barrett's esophagus (BE). Roux-en-Y gastric bypass (RYGB) could alter the natural course of BE. Data on BE progression after RYGB are scarce. OBJECTIVES To study endoscopic surveillance and endoscopic eradication therapy (EET) outcomes of BE in post-RYGB patients versus controls with obesity. SETTING Academic referral centers, a retrospective cohort study. METHODS Patients who underwent RYGB with biopsy-proven BE or intramucosal esophageal adenocarcinoma (IM-EAC) with an endoscopic follow-up of at least 12 months were identified from a prospectively maintained database between January 1992 and February 2019 at 3 tertiary care centers. RYGB patients were matched 1-to-2 to patients with obesity (body mass index > 30 kg/m2) by the initial BE stage at diagnosis. Surveillance and EET outcomes were compared. RESULTS A total of 147 patients were included (49 RYGB and 98 BE stage-matched controls with obesity). For endoscopic surveillance, the rate of disease progression to high-grade dysplasia /IM-EAC was significantly lower in the RYGB patients than controls (2.6% versus 40.2%, respectively; P < .0001), with a comparable median follow-up time (85 months versus 80 months, respectively). This effect persisted in a multivariate analysis, with a hazard ratio of .09 (95% confidence interval, .01-.69). For EET, no difference in the rate of achieving complete remission of intestinal metaplasia was observed between the RYGB and control groups (71.2% versus 81.3%, respectively; P = .44). CONCLUSION RYGB appears to be a protective factor for disease progression to neoplastic BE during endoscopic surveillance. However, disease progression was still observed after RYGB, warranting continuing endoscopic surveillance. EET appeared to be equally effective between RYGB patients and controls with obesity.
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Affiliation(s)
| | - Karim Osman
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Reem Matar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Serge Baroud
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Yuri Hanada
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - F N U Chesta
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Daniel B Maselli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Tala Mahmoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Kenneth K Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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35
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Navarini D, Madalosso CAS, Tognon AP, Fornari F, Barão FR, Gurski RR. Predictive Factors of Gastroesophageal Reflux Disease in Bariatric Surgery: a Controlled Trial Comparing Sleeve Gastrectomy with Gastric Bypass. Obes Surg 2021; 30:1360-1367. [PMID: 32030616 DOI: 10.1007/s11695-019-04286-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) on gastroesophageal reflux disease (GERD) in patients with obesity. METHODS Patients with class II or III obesity were treated with LSG or LRYGB. Procedure choice was based on patients and surgeon preferences. GERD symptoms, endoscopy, barium swallow X-ray, esophageal manometry, and 24-h pH monitoring were obtained before and 1 year after surgery. RESULTS Seventy-five patients underwent surgery (83% female, 39.3 ± 12.1 years, BMI of 41.5 ± 5.1 kg/m2): 35 (46.7%) had LSG and 40 (53.3%) LRYGB. LSG patients had lower BMI (40.3 ± 4.0 kg/m2 vs. 42.7 ± 5.7 kg/m2; p = 0.041) and trend toward lower prevalence of GERD (20% vs. 40%; p = 0.061). One year after surgeries, GERD was more frequent in LSG patients (74% vs. 25%; p < 0.001) and all LSG patients with preoperative GERD continue to have GERD postoperatively. De novo GERD occurred in 19 of 28 (67.9%) of LSG patients and 4 of 24 (16.7%) patients treated with LRYGB (OR 10.6, 95%CI 2.78-40.1). Independent predictors for post-operative GERD were as follows: LSG (OR 12.3, 95%CI 2.9-52.5), preoperative esophagitis (OR 8.5, 95% CI 1.6-44.8), and age (OR 2.0, 95%CI 1.1-3.4). CONCLUSIONS One year after surgery, persistent or de novo GERD were substantially more frequent in patients treated with LSG compared with LRYGB. LSG was the strongest predictor for GERD in our trial. Preoperative counseling and choice of bariatric surgical options must include a detailed assessment and discussion of GERD-related surgical outcomes.
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Affiliation(s)
- Daniel Navarini
- Gastrobese Clinic, Passo Fundo, RS, Brazil.,Hospital São Vicente de Paulo, Passo Fundo, RS, Brazil.,Universidade de Passo Fundo, Passo Fundo, RS, Brazil.,Programa de Pós-Graduação: Ciências Cirúrgicas, Faculdade de Medicina, Departamento de Cirurgia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Carlos Augusto S Madalosso
- Gastrobese Clinic, Passo Fundo, RS, Brazil. .,Hospital São Vicente de Paulo, Passo Fundo, RS, Brazil. .,Universidade de Passo Fundo, Passo Fundo, RS, Brazil. .,Gastrobese Clinic, Rua Uruguai 1953, 8° andar, Passo Fundo, RS, CEP 99010112, Brazil.
| | | | - Fernando Fornari
- Hospital São Vicente de Paulo, Passo Fundo, RS, Brazil.,Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | - Fábio R Barão
- Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | - Richard R Gurski
- Programa de Pós-Graduação: Ciências Cirúrgicas, Faculdade de Medicina, Departamento de Cirurgia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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36
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Abu Sneineh M, Abu Sneineh M, Abu Sneineh M, Abu Sneineh M, Abu Sneineh M, Abu Sneineh M. Sleeve Gastrectomy Is the Most Common Cause of Gastroesophageal Reflux Disease in Comparison with Other Bariatric Operations. Dig Dis 2021; 39:462-466. [PMID: 33440373 DOI: 10.1159/000514377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/07/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) is one of the complications of bariatric operations that might affect the quality of life. We aim to perform a retrospective cohort study to determine the incidence of symptomatic GERD following different types of bariatric surgery and which operations are considered a contraindication of GERD. Besides, we are attempting to identify the risk factors of GERD after bariatric surgery. METHODS Medical records of 729 patients who had undergone bariatric operations between January 2010 and June 2019 at the Shamir (Assaf Harofeh) Medical Center were reviewed. RESULTS There was a significant difference between the type of bariatric procedure and the incidence of GERD symptoms after the operation. The incidence of symptomatic GERD in patients who underwent sleeve gastrectomy (SG) was 39.9% (p = 0.0131). This was significantly higher compared to 16.4% following Roux-en-Y gastric bypass, 23.4% following laparoscopic adjustable gastric band, and 11% following one anastomosis gastric bypass. 113 patients out of 718 had a positive swallow test, and of these patients, 71 developed GERD symptoms postoperatively without correlation to the degree of reflux at the swallow test but with statistically significant correlation to the type of operation especially for SG (p value < 0.001), and to our knowledge, this was never reported in the literature. CONCLUSION SG is a good bariatric procedure option but should be considered carefully in asymptomatic patients with reflux at contrast swallow study and symptomatic GERD patients preoperatively because of high levels of symptomatic GERD postoperatively. Asymptomatic reflux at contrast swallow study preoperatively could be considered a risk factor for GERD after the operation. More studies are needed to be performed on this subject with the addition of postoperative contrast swallow test and pH monitoring preoperatively and postoperatively.
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Affiliation(s)
- Midhat Abu Sneineh
- Department of General Surgery, Bariatric Unit, AZ Sint Jan Hospital, Bruges, Belgium,
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37
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Summe KL, Hawasli A. Can lower preoperative 48-hour pH score predict reflux resolution after sleeve gastrectomy. Am J Surg 2020; 221:578-580. [PMID: 33413875 DOI: 10.1016/j.amjsurg.2020.12.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/04/2020] [Accepted: 12/24/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Morbidly-obese patients with reflux who are undergoing sleeve gastrectomy (SG) may experience resolution, or persistent reflux. We studied factors associated with reflux resolution after SG. METHOD We evaluated baseline weight, body mass index, and DeMeester score (DMS) in patients with reflux undergoing SG. Outcome measure was resolution of reflux post-operatively. RESULTS Study group included 70 patients; 33 (47.1%) patients reported resolution of reflux (RR group) after surgery; 37 (52.9%) patients didn't have resolution (NR group). Pre-operative weight, body mass index, percent excess BMI loss and presence of ≤2 cm hiatal hernia (HH) were similar between the two groups. Males and lower pre-operative DMS were associated with resolution of reflux (18.4 ± 13 vs. 29.1 ± 26, p = 0.03). CONCLUSION Lower pre-SG DeMeester score tend to imply ability to resolve reflux in morbidly-obese patients thus, SG may still be offered, without repair of ≤2 cm HH if present. Unfortunately, it can't be used as the only factor.
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Affiliation(s)
- Karen L Summe
- Ascension St John Hospital, 22101 Moross Road, Detroit, MI, 48236, USA; Beaumont Hospital Grosse Pointe, 468 Cadieux Road, Grosse Pointe, MI, 48230, USA
| | - Abdelkader Hawasli
- Ascension St John Hospital, 22101 Moross Road, Detroit, MI, 48236, USA; Beaumont Hospital Grosse Pointe, 468 Cadieux Road, Grosse Pointe, MI, 48230, USA.
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38
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Benvenga R, Roussel J, Cohen R, Bouchoucha M, Bendacha Y, Catheline JM. Long-term endoscopic follow-up after sleeve gastrectomy. J Visc Surg 2020; 159:39-42. [PMID: 33257281 DOI: 10.1016/j.jviscsurg.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic follow-up after sleeve gastrectomy (SG) sometime reveals worrisome findings as the presence of major digestive lesions such as esophagitis, Barrett's esophagus (BE), and also esophageal cancer. OBJECTIVES The aim of this study was to investigate the frequency and severity of esophageal and gastric lesions after SG. METHODS Our team collected the results of esogastric endoscopies performed on patients who underwent SG up to five years before in our hospital, from April 2010 to August 2014. Summons were sent by mail to all patients operated on between those dates. The results were collected from January 2018 to June 2019. RESULTS Of the 765 patients who underwent SG up to five years before, only 78 (10.2%) agreed to undergo an upper digestive endoscopy. The average age before surgery was 51 years (range: 25-70 years). The mean preoperative body mass index (BMI) was 44.2±4.6kg/m2. For 12 out of these 78 patients (15.4%) it was revisional surgery: 9 SG after gastric banding, and 3 revisional SG (Re-SG). With an average follow-up of 6.3±0.8 years, the endoscopic results of the 78 patients were found to be normal in 31 cases (39.7%): gastritis was found in 28 patients (35.9%), severe grade C or D esophagitis was found in 15 cases (19.2%), hiatal hernia in 18 cases (23.1%), a benign gastric polyp in 2 cases (2.6%). Of the 28 patients with gastritis, HelicobacterPylori was detected in 8 cases (28.6%). No cancer was diagnosed, and BE after SG was found in only one case (1.3%) (normal before surgery). Six of 15 patients with esophagitis (40%) had reflux symptoms. Fourteen of these patients (93.3%) developed de novo esophagitis. CONCLUSION Only 10.2% of operated patients agreed to a long-term esogastric endoscopy. The frequency and severity of endoscopic anomalies observed with an average follow-up of more than 6 years pleads for a policy of systematic upper endoscopies of long-term control after SG.
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Affiliation(s)
- R Benvenga
- Department of digestive surgery, centre hospitalier de Saint-Denis, 2, rue du Docteur Delafontaine, 93200 Saint-Denis, France.
| | - J Roussel
- Department of digestive surgery, centre hospitalier de Saint-Denis, 2, rue du Docteur Delafontaine, 93200 Saint-Denis, France.
| | - R Cohen
- Department of digestive surgery, centre hospitalier de Saint-Denis, 2, rue du Docteur Delafontaine, 93200 Saint-Denis, France.
| | - M Bouchoucha
- Department of gastroenterology, hôpital Avicenne AP-HP, route de Stalingrad, 93000 Bobigny, France.
| | - Y Bendacha
- Department of digestive surgery, centre hospitalier de Saint-Denis, 2, rue du Docteur Delafontaine, 93200 Saint-Denis, France.
| | - J-M Catheline
- Department of digestive surgery, centre hospitalier de Saint-Denis, 2, rue du Docteur Delafontaine, 93200 Saint-Denis, France.
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Makiewicz K, Berbiglia L, Douglas D, Bohon A, Zografakis J, Dan A. Prevalence of Upper Gastrointestinal Pathology in Patients with Obesity on Preoperative Endoscopy. JSLS 2020; 24:JSLS.2020.00021. [PMID: 32612344 PMCID: PMC7316525 DOI: 10.4293/jsls.2020.00021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background and Objectives: The preoperative work up for bariatric surgery is variable and not all centers perform a preoperative upper gastrointestinal endoscopy. A study was undertaken to determine the frequency of clinically significant gross endoscopic and pathological diagnoses in a large sample of patients with obesity undergoing work-up for bariatric surgery. Methods: Routine endoscopy was performed on all preoperative bariatric patients. A retrospective chart review of 1000 consecutive patients was performed. Patients were divided into three groups: Group A (no endoscopic findings), Group B (clinically insignificant findings), Group C (clinically significant findings). Results: Patients had a mean body mass index (BMI) of 49 kg/m2 and 79% were female. In this sample one finding was found on preoperative EGD in 95.2% of patients, 33.9% had at least two diagnoses, and 29.9% had three or more diagnoses. Group A (no findings) consisted of 4.8% of patient, 52.5% in Group B (clinically insignificant findings), and 42.7% were in Group C (clinically significant findings). Clinically significant findings included hiatal hernia 23.5%, esophagitis 9.5%, H. pylori 7.1%, gastric erosions 5.7%, duodenitis 3.7%, Barrett's esophagus 3.1%, and Schatzki ring 1.2%. There was no significant correlation between preoperative BMI and any endoscopic findings (all p-value 0.05). Patients in Group C were statistically older than Groups A and B. Conclusion: Upper gastrointestinal pathology is highly common in patients with obesity. There is a significant rate of clinically significant endoscopy findings and all bariatric surgery patients should undergo preoperative endoscopy.
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Affiliation(s)
| | | | | | - Ashley Bohon
- Summa Health, Akron City Hospital, Akron, OH, USA
| | | | - Adrian Dan
- Summa Health, Akron City Hospital, Akron, OH, USA
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Bevilacqua LA, Obeid NR, Yang J, Zhu C, Altieri MS, Spaniolas K, Pryor AD. Incidence of GERD, esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma after bariatric surgery. Surg Obes Relat Dis 2020; 16:1828-1836. [DOI: 10.1016/j.soard.2020.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/31/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023]
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Castagneto-Gissey L, Genco A, Del Corpo G, Badiali D, Pronio AM, Casella G. Sleeve gastrectomy and gastroesophageal reflux: a comprehensive endoscopic and pH-manometric prospective study. Surg Obes Relat Dis 2020; 16:1629-1637. [PMID: 32847760 DOI: 10.1016/j.soard.2020.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 01/14/2023]
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Vitiello A, Berardi G, Velotti N, De Palma GD, Musella M. Should Sleeve Gastrectomy Be Considered Only as a First Step in Super Obese Patients? 5-Year Results From a Single Center. Surg Laparosc Endosc Percutan Tech 2020; 31:203-207. [PMID: 32956334 DOI: 10.1097/sle.0000000000000866] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/14/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Sleeve gastrectomy (SG) has been originally conceived as a first step procedure for super obese (SO) patients, but it is currently considered a stand-alone intervention. Medium-term to long-term studies have shown weight regain and risk of de novo gastroesophageal reflux (GERD). The aim of this study was to evaluate outcomes of SG in SO subjects. MATERIALS AND METHODS A retrospective analysis of a prospectively maintained database was carried out to find all SO patients who had undergone SG with a minimum follow-up of 5 years. Inclusion criteria were preoperative endoscopy negative for esophagitis and/or hiatal hernia, and no GERD or acid reduction medication before SG. Reflux symptoms were evaluated using a validated questionnaire and endoscopy. Remission rates from comorbidities and percentage of excess body mass index (BMI) loss were recorded. RESULTS A total of 66 (45 male/21 female) patients were included in our study. Mean preoperative BMI and age were 57.4±5.8 kg/m2 and 32.7±11.2 years, respectively. After 5 years, mean percentage of excess BMI loss was 56.42±27.8, and remission rates from hypertension, diabetes, and dyslipidemia were 33.3%, 5.3%, and 20%, respectively. After 5 years, new-onset GERD occurred in 66.7% of patients and 33.3% were taking acid reduction medication. Endoscopy revealed 12 (18.2%) cases of esophagitis ≥grade A. CONCLUSIONS After 5 years, weight loss in SO patients is satisfactory, but the vast majority of patients is still in class II obesity, and resolution of comorbidities is disappointing. High rates of de novo GERD and esophagitis may occur.
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Affiliation(s)
| | | | | | - Giovanni D De Palma
- Clinical Medicine and Surgery, Naples "Federico II" University, AOU "Federico II," Naples, Italy
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Bhargava A, Andrade R. Giant paraesophageal hernia: What do we really know? JTCVS Tech 2020; 3:367-372. [PMID: 34317934 PMCID: PMC8305721 DOI: 10.1016/j.xjtc.2020.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/10/2020] [Accepted: 08/10/2020] [Indexed: 01/07/2023] Open
Affiliation(s)
- Amit Bhargava
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn
| | - Rafael Andrade
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn
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Ahuja A, Mahawar K. Bariatric surgery in patients with gastroesophageal reflux disease and/or hiatus hernia. MINERVA CHIR 2020; 75:345-354. [PMID: 32773756 DOI: 10.23736/s0026-4733.20.08486-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) and hiatus hernia (HH) are frequently encountered comorbidities in patients seeking bariatric and metabolic surgery (BMS) for obesity. sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) are the three commonest bariatric procedures performed worldwide. The purpose of this review was to analyze and compare the data on outcomes of these three procedures in patients with GERD and/or HH. EVIDENCE ACQUISITION We examined published English language scientific literature available on PubMed for data comparing SG, RYGB, and OAGB with specific focus on GERD outcomes and outcomes in those with GERD and/or HH. EVIDENCE SYNTHESIS Several authors have addressed the outcome of GERD after bariatric surgery. There have been randomized control trials and comparative studies in the literature comparing the results of these procedure. But very few studies have exclusively looked into the outcome of different procedures in patients with pre-existing GERD and/or HH. In this narrative review, we evaluate pros and cons of three commonest bariatric procedures worldwide in this subgroup of patients seeking BMS. We also suggest an algorithm on the basis of our experience and the available data in scientific literature. CONCLUSIONS Though RYGB is the best anti reflux procedure it is associated with significant higher morbidity/mortality as compared to SG and OAGB. These two procedures can be used in the majority of patients with GERD and/or HH seeking BMS with an acceptance that some patients will need conversion to RYGB in the long term.
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Affiliation(s)
- Anmol Ahuja
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India -
| | - Kamal Mahawar
- Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK.,Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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Ma P, Higa K. Laparoscopic modified Nissen fundoplication over Roux-en-Y gastric bypass and hiatal hernia repair for intractable gastroesophageal reflux. Surg Obes Relat Dis 2020; 16:1877-1878. [PMID: 32763105 DOI: 10.1016/j.soard.2020.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Pearl Ma
- Department of Surgery, University of California San Francisco, Fresno, California; Advanced Laparoscopic Surgery Associates, Fresno, California.
| | - Kelvin Higa
- Department of Surgery, University of California San Francisco, Fresno, California; Advanced Laparoscopic Surgery Associates, Fresno, California
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Sawas T, Marya NB, Storm AC, Blackmon SH, Abu Dayyeh BK. Laparoscopic hernia repair and fundoplication with endoscopic sleeve gastroplasty for complex hernia and GERD management in morbid obesity. VideoGIE 2020; 5:555-556. [PMID: 33204915 PMCID: PMC7651751 DOI: 10.1016/j.vgie.2020.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Tarek Sawas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Neil B Marya
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Shanda H Blackmon
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Colpaert J, Horevoets J, Maes L, Uijtterhaegen G, Dillemans B. Surgical treatment of therapy-resistant reflux after Roux-en-Y gastric bypass. A case series of the modified Nissen fundoplication. Acta Chir Belg 2020; 120:291-296. [PMID: 31746675 DOI: 10.1080/00015458.2019.1696028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Patients with intractable reflux after RYGB have limited treatment options. Here a modified Nissen fundoplication (MNF) as described by N. Kawahara might be the answer.Methods: In this retrospective case study we identified six patients with therapy-resistant GERD after RYGB. All six were treated with a MNF, using the remnant stomach to construct the fundoplication. Short term follow-up 1 month and 6-12 months postoperatively was conducted to inquire about GERD symptoms.Results: Six patients underwent a MNF. Three out of six patients had had a gastric band in their medical history. Upper GI barium swallow test revealed herniation of the gastric pouch in 4/6 patients. After surgery all patients were symptom free and 4/6 completely stopped PPI treatment.Discussion: Mechanisms of new onset or deteriorating GERD after RYGB are herniation of gastric pouch and destruction of the lower esophageal sphincter after banding. Both problems are tackled when constructing a MNF.Conclusion: Complete symptom relief was seen 1 month after MNF. The procedure seems safe, feasible and effective. The study is limited by small sample size and short follow-up yet shows clear improvement of symptoms. Larger trials are needed to establish validity of the MNF.
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Affiliation(s)
- Jan Colpaert
- Department of Surgery, AZ Sint-Jan Brugge, Bruges, Belgium
| | | | - Leander Maes
- Department of Surgery, AZ Sint-Jan Brugge, Bruges, Belgium
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Jaruvongvanich V, Matar R, Ravi K, Murad MH, Vantanasiri K, Wongjarupong N, Ungprasert P, Vargas EJ, Maselli DB, Prokop LJ, Abu Dayyeh BK. Esophageal Pathophysiologic Changes and Adenocarcinoma After Bariatric Surgery: A Systematic Review and Meta-Analysis. Clin Transl Gastroenterol 2020; 11:e00225. [PMID: 32955206 PMCID: PMC7447443 DOI: 10.14309/ctg.0000000000000225] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION To assess the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on acid reflux and esophageal motor function and to evaluate the observation of esophageal adenocarcinoma (EAC) after bariatric surgery. METHODS We searched 5 databases for adults who underwent SG or RYGB and had esophageal pH test and/or esophageal manometry before and after surgery. A separate systemic search of observational studies and a retrospective review at 3 institutions of adults who developed EAC after these surgeries were conducted. Outcomes were changes in manometric and pH parameters and EAC cases after SG and RYGB. RESULTS A total of 27 nonrandomized studies (SG: 612 patients; RYGB: 470 patients) were included. After SG, lower esophageal sphincter pressure and esophageal body amplitude were decreased and the risk of ineffective esophageal motility was increased. Total and recumbent acid exposure times were increased. After RYGB, an increased risk of ineffective esophageal motility was observed. Total, upright, and recumbent acid exposure times were decreased. The total reflux episodes remained unchanged but with increased nonacid reflux and decreased acid reflux events. Including our largest series, 31 EAC cases have been reported to date after SG and RYGB. DISCUSSION This systematic review demonstrates increased acid reflux after SG and decreased acid reflux after RYGB. An observed increased nonacid reflux after RYGB might contribute to failure of gastroesophageal reflux disease improvement. This refluxate might be noxious to the esophagus, warranting further studies. RYGB might not entirely preserve esophageal function as previously believed.
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Affiliation(s)
| | - Reem Matar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Karthik Ravi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - M. Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Kornpong Vantanasiri
- Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Nicha Wongjarupong
- Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Patompong Ungprasert
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA;
| | - Eric J. Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B. Maselli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry J. Prokop
- Division of Library Services, Mayo Clinic, Rochester, Minnesota, USA
| | - Barham K. Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Misra S, Nandhini BD, Christinajoice S, Kumar SS, Prabhakaran S, Palanivelu C, Raj PP. Is Laparoscopic Roux-en-Y Gastric Bypass Still the Gold Standard Procedure for Indians? Mid- to Long-Term Outcomes from a Tertiary Care Center. Obes Surg 2020; 30:4482-4493. [PMID: 32725594 DOI: 10.1007/s11695-020-04849-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Laparoscopic Roux-en-Y gastric bypass (RYGB) is the oldest and most widely performed bariatric surgery worldwide. There is, however, a scarcity of mid- to long-term data of RYGB, especially from the Indian subcontinent. MATERIALS AND METHODS The study was a single-center, retrospective analysis from patients who underwent RYGB between January 2009 and November 2014 from a tertiary care center in India. Percent of total weight loss (%TWL) was taken as the primary outcome of the study. Secondary outcomes included type 2 diabetes mellitus (T2DM) remission, comorbidity resolution, revisional surgeries, and complications related to RYGB at 1 year, at 3 years, and during the long term, following surgery. Postoperative visits took place at 1 and 3 years, while the long-term outcome was at median 8.3 years (range 5.4-11.2 years), with a follow-up of 92.4% (488/528), 80.5% (424/527) and 69.5% (363/522), respectively. RESULTS Out of 528 patients studied, 56% were females. The mean body mass index (BMI) was 40.6 ± 6.9 kg/m2. The %TWL in the long-term follow-up was 21.8 ± 11.3%. T2DM remission rates at 1 year, at 3 years, and during the long term were 84.5%, 70.0%, and 60.0%, respectively. Preoperative HBA1c (p = 0.002) and insulin usage (p = 0.016) had a significant predictive effect on T2DM remission. Gastroesophageal reflux disease (GERD) improved significantly (p < 0.001). Early (< 30 days) and late (> 30 days) complications were observed in 2.3% and 4.3% of the patients, respectively. CONCLUSION Weight loss during mid to long-term follow-up was maintained in the majority of the patients after RYGB. However, a small proportion had significant weight regain in the long term. T2DM, GERD, and other comorbidities were well improved after RYGB.
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Affiliation(s)
- Shivanshu Misra
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - B Deepa Nandhini
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - S Christinajoice
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - S Saravana Kumar
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - S Prabhakaran
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - C Palanivelu
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - P Praveen Raj
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India.
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Carandina S, Soprani A, Montana L, Murcia S, Valenti A, Danan M, d’Agostino J, Rivkine E, Nedelcu M. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass in patients with gastroesophageal reflux disease: results of a multicenter study. Surg Obes Relat Dis 2020; 16:732-737. [PMID: 32222432 DOI: 10.1016/j.soard.2020.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/29/2019] [Accepted: 02/14/2020] [Indexed: 12/18/2022]
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