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Memon MA, Osland E, Yunus RM, Hoque Z, Alam K, Khan S. The effect of laparoscopic vertical sleeve gastrectomy and laparoscopic roux-en-Y gastric bypass on gastroesophageal reflux disease: An updated meta-analysis and systematic review of 5-year post-operative data from randomized controlled trials. Surg Endosc 2024:10.1007/s00464-024-11303-x. [PMID: 39384655 DOI: 10.1007/s00464-024-11303-x] [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: 06/10/2024] [Accepted: 09/22/2024] [Indexed: 10/11/2024]
Abstract
BACKGROUND To evaluate 5-year effect of laparoscopic vertical sleeve gastrectomy (LVSG) versus laparoscopic roux-en-Y gastric bypass (LRYGB) on gastroesophageal reflux disease (GERD) solely based on randomized controlled trials (RCTs). METHODS A systematic review and meta-analysis of 5-year postoperative GERD data comparing LVSG and LRYGB in adults were undertaken. Electronic databases were searched from January 2015 to March 2024 for publications meeting inclusion criteria. The Hartung-Knapp-Sidik-Jonkman random effects model was applied to estimate pooled odds ratio where meta-analysis was possible. Bias and certainty of evidence were assessed using the Cochrane Risk of Bias Tool 2 and GRADE. RESULTS Five RCTs were analysed (LVSG n = 554, LRYGB n = 539). LVSG was associated with increased adverse GERD outcomes compared to LRYGB at 5 years. The odds for revisional surgery to treat GERD in LVSG patients were 11 times higher compared to LRYGB (OR 11.47, 95% CI 1.83 to 71.69; p = 0.02; I2 = 0% High level of certainty). Similarly pharmacological management for increasing GERD was significantly more frequent in LVSG patients compared to LRYGB (OR 3.89, 95% CI 2.31 to 6.55; p ≤ 0.01; I2 = 0% Moderate level of certainty). Overall, LVSG was associated with significantly more interventions (both medical and surgical) for either worsening GERD and/or development of de novo GERD compared to LRYGB (OR 5.98, 95% CI 3.48 to 10.29; p ≤ 0.01; I2 = 0%) Moderate level of certainty). CONCLUSIONS The development and worsening of GERD symptoms are frequently associated with LVSG compared to LRYGB at 5 years postoperatively requiring either initiation or increase of pharmacotherapy or failing that revisional bariatric surgery. Appropriate patient/surgical selection is crucial to reduce these postoperative risks of GERD.
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Affiliation(s)
- Muhammed Ashraf Memon
- School of Mathematics, Physics and Computing and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia.
- Sunnybank Obesity Centre & South East Queensland Surgery (SEQS), Sunnybank, QLD, Australia.
- Mayne Medical School, School of Medicine, University of Queensland, Brisbane, QLD, Australia.
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
- Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK.
| | - Emma Osland
- Department of Dietetics and Food Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Department of Human Movements and Nutrition, University of Queensland, Brisbane, QLD, Australia
| | | | - Zahirul Hoque
- School of Mathematics, Physics and Computing, University of Sourthern Queensland, Toowoomba, QLD, Australia
| | - Khorshed Alam
- School of Business & Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Shahjahan Khan
- School of Mathematics, Physics and Computing and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
- School of Science and Engineering, Asian University of Bangladesh, Dhaka, Bangladesh
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Memon MA, Osland E, Yunus RM, Alam K, Hoque Z, Khan S. Gastroesophageal reflux disease following laparoscopic vertical sleeve gastrectomy and laparoscopic roux-en-Y gastric bypass: meta-analysis and systematic review of 5-year data. Dis Esophagus 2024; 37:doad063. [PMID: 37935430 DOI: 10.1093/dote/doad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/14/2023] [Indexed: 11/09/2023]
Abstract
To compare 5-year gastroesophageal reflux outcomes following Laparoscopic Vertical Sleeve Gastrectomy (LVSG) and Laparoscopic Roux-en-Y gastric bypass (LRYGB) based on high quality randomized controlled trials (RCTs). We conducted a sub-analysis of our systematic review and meta-analysis of RCTs of primary LVSG and LRYGB procedures in adults for 5-year post-operative complications (PROSPERO CRD42018112054). Electronic databases were searched from January 2015 to July 2021 for publications meeting inclusion criteria. The Hartung-Knapp-Sidik-Jonkman random effects model was utilized to estimate weighted mean differences where meta-analysis was possible. Bias and certainty of evidence was assessed using the Cochrane Risk of Bias Tool 2 and GRADE. Four RCTs were included (LVSG n = 266, LRYGB n = 259). An increase in adverse GERD outcomes were observed at 5 years postoperatively in LVSG compared to LRYGB in all outcomes considered: Overall worsened GERD, including the development de novo GERD, occurred more commonly following LVSG compared to LRYGB (OR 5.34, 95% CI 1.67 to 17.05; p = 0.02; I2 = 0%; (Moderate level of certainty); Reoperations to treat severe GERD (OR 7.22, 95% CI 0.82 to 63.63; p = 0.06; I2 = 0%; High level of certainty) and non-surgical management for worsened GERD (OR 3.42, 95% CI 1.16 to 10.05; p = 0.04; I2 = 0%; Low level of certainty) was more common in LVSG patients. LVSG is associated with the development and worsening of GERD symptoms compared to LRYGB at 5 years postoperatively leading to either introduction/increased pharmacological requirement or further surgical treatment. Appropriate patient/surgical selection is critical to minimize these postoperative risks.
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Affiliation(s)
- Muhammed A Memon
- School of Mathematics, Physics and Computing and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
- Sunnybank Obesity Centre & South & East Queensland Surgery (SEQS), McCullough Centre, Suite 9, 259 McCullough Street, Sunnybank, QLD, Australia
- Mayne Medical School, School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK
| | - Emma Osland
- Department of Dietetics and Food Services, Royal Brisbane and Women's Hospital, Herston, QLD 4019, Australia
- Department of Human Movements and Nutrition, University of Queensland, Brisbane, QLD, Australia
| | - Rossita M Yunus
- Institute of Mathematical Sciences, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Khorshed Alam
- School of Business, and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Zahirul Hoque
- School of Mathematics, Physics and Computing, University of Sourthern Queensland, Toowoomba, QLD, Australia
| | - Shahjahan Khan
- School of Mathematics, Physics and Computing and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
- School of Science and Engineering, Asian University of Bangladesh, Dhaka, Bangladesh
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Masood M, Low DE, Deal SB, Kozarek RA. Current Management and Treatment Paradigms of Gastroesophageal Reflux Disease following Sleeve Gastrectomy. J Clin Med 2024; 13:1246. [PMID: 38592683 PMCID: PMC10932325 DOI: 10.3390/jcm13051246] [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: 01/15/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Obesity is associated with serious comorbidities and economic implications. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, are effective options for weight loss and the improvement of obesity-related comorbidities. With the growing obesity epidemic, there has been a concomitant rise in bariatric surgeries, particularly in sleeve gastrectomy, which has been the most widely performed bariatric surgery since 2013. Gastroesophageal reflux disease (GERD) is highly prevalent in obese individuals, can significantly impact quality of life and may lead to serious complications. Obesity and GERD both improve with weight loss. However, as the incidence of sleeve gastrectomy rises, recent data have revealed a risk of exacerbation of pre-existing GERD or the development of de novo GERD following sleeve gastrectomy. We performed a detailed review of GERD post-sleeve gastrectomy, including its overall incidence, pathophysiology and current treatment paradigms.
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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 E. Low
- Division of Thoracic Surgery, Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA 98101, USA;
| | - Shanley B. Deal
- Division of General and Bariatric 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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Sujka J, McEwen C, Sandhu M, Sunderland M, Mhaskar R, Mooney A, DuCoin C. Staple Line Bacterial Load May Not Be a Contra-Indication to Magnetic Sphincter Augmentation Placement During Primary Sleeve Gastrectomy. Obes Surg 2023; 33:3703-3705. [PMID: 37792251 DOI: 10.1007/s11695-023-06869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Joseph Sujka
- Department of Surgery, University of South Florida, Tampa, FL, USA.
| | - Courtney McEwen
- University of South Florida College of Medicine, Tampa, FL, USA
| | - Mannat Sandhu
- University of South Florida College of Medicine, Tampa, FL, USA
| | | | - Rahul Mhaskar
- University of South Florida College of Medicine, Tampa, FL, USA
| | - Ashley Mooney
- Department of Surgery, University of South Florida, Tampa, FL, USA
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Fernández-Ananín S, Balagué Ponz C, Sala L, Molera A, Ballester E, Gonzalo B, Pérez N, Targarona EM. Gastroesophageal reflux after sleeve gastrectomy: The dimension of the problem. Cir Esp 2023; 101 Suppl 4:S26-S38. [PMID: 37952718 DOI: 10.1016/j.cireng.2023.05.019] [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: 05/02/2023] [Accepted: 05/28/2023] [Indexed: 11/14/2023]
Abstract
Sleeve gastrectomy is a safe and effective bariatric surgery in terms of weight loss and longterm improvement or resolution of comorbidities. However, its achilles heel is the possible association with the development with the novo and/or worsening of pre-existing gastroesophageal reflux disease. The anatomical and mechanical changes that this technique induces in the esophagogastric junction, support or contradict this hypothesis. Questions such as «what is the natural history of gastroesophageal reflux in the patient undergoing gastric sleeve surgery?», «how many patients after vertical gastrectomy will develop gastroesophageal reflux?» and «how many patients will worsen their previous reflux after this technique?» are intended to be addressed in the present article.
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Affiliation(s)
- Sonia Fernández-Ananín
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Carme Balagué Ponz
- Unidad de Cirugía Esofagogástrica, Bariátrica y Metabólica, Servicio de Cirugía General y Digestiva, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Laia Sala
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Antoni Molera
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eulalia Ballester
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Berta Gonzalo
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Noelia Pérez
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eduardo M Targarona
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Ertekin SC. The Efficacy of Omentopexy During Laparoscopic Sleeve Gastrectomy: Comparative Analysis of Surgical Outcomes, Complications, and Quality of Life. Cureus 2023; 15:e45201. [PMID: 37842474 PMCID: PMC10576198 DOI: 10.7759/cureus.45201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION The increasing popularity of laparoscopic sleeve gastrectomy (LSG) as a bariatric procedure has been accompanied by concerns about potential complications, including staple line bleeding and leaks. Additionally, postoperative quality of life can be affected by gastroesophageal reflux disease (GERD) and food-related issues. In light of these factors, there is a need to compare the outcomes of standard LSG with LSG with omentopexy. This comparative analysis aims to provide insights into the distinct recovery processes associated with these two approaches. MATERIALS AND METHODS This retrospective study aimed to compare the outcomes of LSG in two groups: LSG alone and LSG with omentopexy. Data collected from January 2022 to April 2022 included patient characteristics, surgical details, complications, medication usage, and follow-up. Gastrointestinal Quality of Life Index (GIQLI) scores were recorded at postoperative intervals of 15 days, one month, and three months. RESULTS This study analyzed 29 patients who underwent standard LSG and 36 patients who underwent LSG combined with omentopexy. The two groups exhibited similarities in terms of age, gender, body mass index (BMI), comorbidities, surgical duration, complications, hospitalization duration, and medication requirements (p > 0.005). Telephone consultations were significantly higher in the LSG with omentopexy group (p < 0.001). Nausea (p = 0.486) and vomiting (p = 0.603) rates did not significantly differ, but the constipation rate at one month was higher in LSG with omentopexy (p = 0.244). The flatulence rate at one month was significantly higher in LSG with omentopexy (p < 0.007). GIQLI scores were significantly lower in LSG with omentopexy at 15 days (p < 0.001) and one month (p < 0.001), but not at three months (p = 0.884). CONCLUSION This study demonstrates that LSG and LSG with omentopexy have similar surgical outcomes and short-term complications. However, differences exist in postoperative symptoms and quality of life experiences.
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Affiliation(s)
- Suleyman Caglar Ertekin
- General Surgery, Private Clinic, Izmir, TUR
- General Surgery, Altınbas University, İstanbul, TUR
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [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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Sleeve gastrectomy morphology and long-term weight-loss and gastroesophageal reflux disease outcomes. Surg Endosc 2023:10.1007/s00464-022-09555-6. [PMID: 36645483 DOI: 10.1007/s00464-022-09555-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/08/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND The relationship between sleeve gastrectomy (SG) morphology and long-term weight-loss and gastroesophageal reflux disease (GERD) outcomes is unknown. METHODS All patients (n = 268) undergoing SG performed by 3 surgeons at a single academic institution from January 1, 2010 to December 31, 2012 were included. Long-term weight-loss and GERD outcomes were available for 90 patients which were incorporated in analyses. SG morphology was determined from postoperative day 1 upper gastrointestinal series (UGIS) available from 50 patients. Images were independently categorized using previously published methodology as Dumbbell (38%), Lower Pouch (22%), Tubular (26%), or Upper Pouch (14%) by Radiologist and Surgeon. Radiologist categorization was used when disagreement occurred (8%). Univariable analyses were conducted to explore potential associations between SG morphology, weight loss, and GERD outcomes. RESULTS Follow-up was 8.2 ± 0.9 years. Population characteristics included age of 45.1 ± 10.8 years, female sex in 83.3%, and hiatal hernia repair (HHR) performed at index SG in 17.8%. Surgeons did not preferentially achieve a specific SG morphology. Changes from preoperative obesity and associated diseases comprised body mass index (BMI) (49.5 ± 7.6 vs. 39.2 ± 9.4 kg/m2; p < 0.0001), diabetes mellitus (30.0 vs. 12.2%; p = 0.0006), hypertension (70.0 vs. 54.4%; p = 0.0028), hyperlipidemia (42.2 vs. 24.2%;p = 0.0017), obstructive sleep apnea (41.1 vs. 15.6%; p < 0.0001), osteoarthritis (48.9 vs. 13.3%; p < 0.0001), back pain (46.5 vs. 28.9%; p = 0.0035), and medications (4.8 ± 3.3 vs. 3.7 ± 3.5; p < 0.0001). Dumbbell SG morphology was associated with lesser reduction in BMI at follow-up (--6.8 ± 7.2 vs. -12.4 ± 8.3 kg/m2; p = 0.0196) while greater BMI change was appreciated with Lower Pouch SG shape (-16.9 ± 9.9 vs. -8.4 ± 6.8 kg/m2; p = 0.0017). GERD was more prevalent at follow-up than baseline (67.8 vs. 47.8%; p < 0.0001). GERD-specific outcomes included de novo (51.1%), persistent (27.9%), worsened (58.1%), and resolved (14.0%) disease. Ten patients underwent reoperation for refractory GERD with SG morphology corresponding to Dumbbell (n = 5) and Upper Pouch (n = 1) for those with available UGIS. Univariable analyses showed that patients with GERD experienced a larger reduction in BMI compared with patients without GERD (-11.8 ± 7.7 vs. -7.0 ± 5.1 kg/m2; p = 0.0007). Patient age, surgeon, morphology category, and whether a HHR was done at index SG were not associated with the presence of any, de novo, or worsened GERD. Female sex was associated with worsened GERD (96.0 vs. 4.0%; p = 0.0455). Type of calibration device, distance from staple line to pylorus, and whether staple line reinforcement was used were not associated with SG morphology classification. CONCLUSION This is the first study assessing the impact of SG morphology on long-term weight loss and GERD. Our data suggest an association between SG morphology and long-term weight loss but not with GERD outcomes. Current technical standards may be limited in reproducing the same SG morphology. This information may help guide the technical optimization and standardization of SG. Surgeons did not favor a specific SG morphology (1). Our results signal to a relationship between radiographic assessment of SG morphology and long-term weight-loss outcomes with Dumbbell classification correlated with lesser reduction in BMI (2a) and Lower Pouch morphology associated with superior weight loss (2b). SG, sleeve gastrectomy; BMI, body mass index.
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da Silva JTD, Santa-Cruz F, Cavalcanti JMS, Padilha MV, Coutinho LR, Siqueira LT, Ferraz ÁAB. Incidence of Abnormalities of the Gastric Tube Following Sleeve Gastrectomy and Its Role on Esophagitis Progression. Obes Surg 2023; 33:263-267. [PMID: 36460942 DOI: 10.1007/s11695-022-06375-4] [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: 03/03/2022] [Revised: 11/20/2022] [Accepted: 11/27/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE The purpose of this study is to determine the incidence of gastric tube abnormalities after SG and its relationship with esophagitis progression. METHODS Retrospective study which included 459 patients in the postoperative period of SG who underwent an esophagogastroduodenoscopy in both pre- and postoperative periods. The main studied variables were presence of gastric tube abnormalities (dilation, neofundus, twist, and hiatal hernia) and esophagitis progression. RESULTS Among the 459 patients who underwent SG, 393 (85.6%) were women, and 66 (14.4%) men, with mean age of 40.4 years. Mean preoperative BMI was 39.70 kg/m2. In total, 20.3% of the sample presented progression of esophagitis after surgery. Among the whole sample, 130 (28.3%) presented with an abnormality of the remnant gastric tube. The most common alteration was gastric dilation, which occurred in 16.1% of the patients, followed by gastric twist (10.7%), neofundus (7.4%), and hiatal hernia (0.2%). Patients who presented with any abnormality of the gastric tube were significantly prone to presenting esophagitis progression (p = 0.013). When analyzing each morphological abnormality isolated, there was no statistically significant correlation. CONCLUSION Abnormalities of the gastric tube are not uncommon after SG and seems to contribute partially to the relevant rates of GERD and esophagitis after this surgery.
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Affiliation(s)
- José-Tarcísio Dias da Silva
- Federal University of Pernambuco, Recife, PE, Brazil.,General Surgery Unit, Hospital das Clínicas (HC-UFPE/EBSERH), Federal University of Pernambuco, Recife, PE, Brazil
| | | | - Joyce Maria S Cavalcanti
- General Surgery Residency, Hospital das Clínicas (HC-UFPE/EBSERH), Federal University of Pernambuco, Recife, PE, Brazil
| | | | - Lucas R Coutinho
- Medical School, Federal University of Pernambuco, Recife, PE, Brazil
| | - Luciana T Siqueira
- General Surgery Unit, Hospital das Clínicas (HC-UFPE/EBSERH), Federal University of Pernambuco, Recife, PE, Brazil
| | - Álvaro A B Ferraz
- General Surgery Unit, Hospital das Clínicas (HC-UFPE/EBSERH), Federal University of Pernambuco, Recife, PE, Brazil. .,Gastrointestinal Surgery Unit, Hospital Esperança - Rede D'Or São Luiz, Recife, PE, Brazil.
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Hider AM, Bonham AJ, Carlin AM, Finks JF, Ghaferi AA, Varban OA, Ehlers AP. Impact of concurrent hiatal hernia repair during laparoscopic sleeve gastrectomy on patient-reported gastroesophageal reflux symptoms: a state-wide analysis. Surg Obes Relat Dis 2022; 19:619-625. [PMID: 36586763 DOI: 10.1016/j.soard.2022.12.021] [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: 07/28/2022] [Revised: 10/21/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Concurrent hiatal hernia repair (HHR) during laparoscopic sleeve gastrectomy (LSG) may improve gastroesophageal reflux disease (GERD) symptoms. However, patient-reported outcomes are limited, and the influence of surgeon technique remains unclear. OBJECTIVES To assess patient-reported GERD severity before and after LSG with and without concomitant HHR. SETTING Teaching and non-teaching hospitals participating in a state-wide quality improvement collaborative. METHODS Using a state-wide bariatric-specific data registry, all patients who underwent a primary LSG between 2015 and 2019 who completed a baseline and 1 year validated GERD health related quality of life (GERD-HRQL) survey were identified (n = 11,742). GERD severity at 1 year as well as 30-day risk-adjusted adverse events was compared between patients who underwent LSG with or without HHR. Results were also stratified by anterior versus posterior HHR. RESULTS A total of 4015 patients underwent a LSG-HHR (34%). Compared to patients who underwent LSG without HHR, LSG-HHR patients were older (47.8 yr versus 44.6 yr; P < .0001), had a lower preoperative body mass index (BMI) (45.8 kg/m2 versus 48 kg/m2; P < .0001) and more likely to be female (85.2% versus 77.6%, P < .0001). Patients who underwent a posterior HHR (n = 3205) experienced higher rates of symptom improvement (69.5% versus 64.0%, P = .0014) and lower rates of new onset symptoms at 1 year (28.2% versus 30.2%, P = .0500). Patients who underwent an anterior HHR (n = 496) experienced higher rates of hemorrhage and readmissions with no significant difference in symptom improvement. CONCLUSIONS Concurrent posterior hiatal HHR at the time of sleeve gastrectomy can improve reflux symptoms. Patients undergoing anterior repair derive no benefit and should be avoided.
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Affiliation(s)
- Ahmad M Hider
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.
| | - Aaron J Bonham
- Center for Healthcare Outcomes & Policy, Ann Arbor, Michigan
| | | | - Jonathan F Finks
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Amir A Ghaferi
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes & Policy, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Oliver A Varban
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Anne P Ehlers
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes & Policy, Ann Arbor, Michigan
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Zhang T, Zhang B, Tian W, Wei Y, Wang F, Yin X, Wei X, Liu J, Tang X. Trends in gastroesophageal reflux disease research: A bibliometric and visualized study. Front Med (Lausanne) 2022; 9:994534. [PMID: 36250094 PMCID: PMC9556905 DOI: 10.3389/fmed.2022.994534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/06/2022] [Indexed: 11/19/2022] Open
Abstract
Background Gastroesophageal reflux disease (GERD), a disorder resulting from the retrograde flow of gastric contents into the esophagus, affects an estimated 10-30% of the Western population, which is characterized by multifactorial pathogenesis. Over the past few decades, there have been many aspects of uncertainty regarding GERD leading to an ongoing interest in the field as reflected by a large number of publications, whose heterogeneity and variable quality may present a challenge for researchers to measure their scientific impact, identify scientific collaborations, and to grasp actively researched themes in the GERD field. Accordingly, we aim to evaluate the knowledge structure, evolution of research themes, and emerging topics of GERD research between 2012 and 2022 with the help of bibliometric approaches. Methods The literature focusing on GERD from 2012 to 2022 was retrieved from the Science Citation Index Expanded of the Web of Science Core Collection. The overall publication performance, the most prolific countries or regions, authors, journals and resources-, knowledge- and intellectual-networking, as well as the co-citation analysis of references and keywords, were analyzed through Microsoft Office Excel 2019, CiteSpace, and VOSviewer. Results A total of 8,964 publications were included in the study. The USA published the most articles (3,204, 35.74%). Mayo Clin ranked first in the number of articles published (201, 2.24%). EDOARDO SAVARINO was the most productive author (86, 0.96%). The most productive journal in this field was SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES (304, 3.39%). AMERICAN JOURNAL OF GASTROENTEROLOGY had the most co-citations (4,953, 3.30%). Keywords with the ongoing strong citation bursts were transoral incision less fundoplication, eosinophilic esophagitis, baseline impedance, and functional heartburn. Conclusion For the first time, we obtained deep insights into GERD research through bibliometric analysis. Findings in this study will be helpful for scholars seeking to understand essential information in this field and identify research frontiers.
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Affiliation(s)
- Tai Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Traditional Chinese Medical Sciences, Beijing, China
- Traditional Chinese Medicine Research Institute of Spleen and Stomach Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Beihua Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Traditional Chinese Medical Sciences, Beijing, China
- Traditional Chinese Medicine Research Institute of Spleen and Stomach Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wende Tian
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuchen Wei
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Traditional Chinese Medical Sciences, Beijing, China
- Traditional Chinese Medicine Research Institute of Spleen and Stomach Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fengyun Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Traditional Chinese Medical Sciences, Beijing, China
- Traditional Chinese Medicine Research Institute of Spleen and Stomach Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaolan Yin
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Traditional Chinese Medical Sciences, Beijing, China
- Traditional Chinese Medicine Research Institute of Spleen and Stomach Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiuxiu Wei
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Traditional Chinese Medical Sciences, Beijing, China
- Traditional Chinese Medicine Research Institute of Spleen and Stomach Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiali Liu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Traditional Chinese Medical Sciences, Beijing, China
- Traditional Chinese Medicine Research Institute of Spleen and Stomach Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xudong Tang
- Traditional Chinese Medicine Research Institute of Spleen and Stomach Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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12
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Yilmaz F, Gedik GK, Yilmaz H. Evaluation of postprandial symptoms in two different laparoscopic sleeve gastrectomy techniques using gastric emptying scintigraphy. Niger J Clin Pract 2022; 25:1875-1882. [DOI: 10.4103/njcp.njcp_315_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Relationship between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a narrative review. Wideochir Inne Tech Maloinwazyjne 2021; 16:648-655. [PMID: 34950258 PMCID: PMC8669989 DOI: 10.5114/wiitm.2021.103948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 01/18/2021] [Indexed: 11/17/2022] Open
Abstract
This paper aims to revisit the relationship between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy in obese patients by reviewing the recent available literature, in the form of a narrative review. The interpretation of the current evidence is challenged by the fact that published data are contradictory and comparison between studies is difficult. Most studies investigate the presence of gastroesophageal reflux disease by assessing only the symptoms reported by patients. A few studies have objectively investigated gastroesophageal reflux disease by functional tests and endoscopic evaluation. Also, the surgical technique of laparoscopic sleeve gastrectomy plays an important role in the incidence of postoperative gastroesophageal reflux disease. In conclusion, surgeons must be aware of the existence of gastroesophageal reflux disease and, at the same time, patients should be informed regarding the possible effect of laparoscopic sleeve gastrectomy on gastroesophageal reflux disease.
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14
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The Outcomes of Revisional One Anastomosis Gastric Bypass Versus Revisional Roux-en-Y Gastric Bypass After Primary Restrictive Procedures: A Prospective Nonrandomized Comparative Study. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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15
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Impact of laparoscopic sleeve gastrectomy on esophageal physiology. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2021; 59:296-302. [PMID: 33600675 DOI: 10.2478/rjim-2021-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Indexed: 11/20/2022]
Abstract
Introduction. Laparoscopic sleeve gastrectomy (LSG) is a popular weight loss surgery technique, but the impact on esophageal physiology and esophagogastric junction is still debatable. The aim of our study was to evaluate the manometric changes of the lower esophageal sphincter (LES) after LSG in order to indicate LES manometry pre- procedure. Methods. In a prospective study we evaluated clinically, with upper gastrointestinal endoscopy, and high-resolution esophageal manometry 45 morbidly obese patients before, and 6-12 months after LSG. Results. The BMI (body mass index) decreased from 46.28±5.79 kg/m2 to 32.28±4.65 kg/m2 postoperatively (p <0.01), with a reduction of ~14 kg/m2 of BMI, 39.9 (±11.9) kg body weight and 29.9 (± 6.2)% of the TWL (Total Weight Loss index), in a median interval of 7.9 months. Gastroesophageal reflux disease (GERD) prevalence increased from 17.8% to 31.1% postoperatively, with new GERD onset in 22.2%, but mild symptomatology (the median GERD-HRQL score increased from 1.56 to 2.84 points). Postoperatory reflux was associated with lower esophageal sphincter (LES) hypotonia, shortening of LES length and IIGP (increased intragastric pressure). Hiatal hernia repair rate was 17.8%, and proton pump inhibitor consumption 20%. After weight loss, the 10 cases of esophagitis discovered preoperatively cured, but 3 patients were diagnosed with de novo esophagitis. The prevalence of manometric dysmotility after LSG was 28.9%, lower than before surgery (44.4%). Conclusion. Even if GERD remains the main limitation of LSG, the high-resolution esophageal manometry has proved useful and should be implemented in morbidly obese evaluation protocol, to better select the bariatric procedure.
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16
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Salman MA, Mikhail HMS, Abdelsalam A, Abdallah A, Elshafey HE, Abouelregal TE, Omar MG, Elkassar H, Ahmed RA, Atallah M, Shaaban HED, Abdellatif Z, Elkholy S, Salman AA. Acceleration of Gastric Emptying and Improvement of GERD Outcome After Laparoscopic Sleeve Gastrectomy in Non-diabetic Obese Patients. Obes Surg 2021; 30:2676-2683. [PMID: 32200446 DOI: 10.1007/s11695-020-04547-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE Obesity has become a pandemic nowadays. Bariatric surgery is increasingly performed to manage obesity. Currently, laparoscopic sleeve gastrectomy (LSG) is a widely accepted procedure given its feasibility and efficacy. Previous studies revealed conflicting results regarding the change of gastric emptying following sleeve gastrectomy. The primary aim of the present study is to assess gastric motor function by gastric emptying scintigraphy in a cohort of non-diabetic patients undergoing laparoscopic sleeve gastrectomy (LSG) for treatment of severe obesity. METHODS This prospective observational study included 100 obese, non-diabetic patients attending the surgery clinic at Cairo University Hospitals and Al Azhar University Hospitals. LSG was performed following a standardized protocol, with no complications observed. All patients had gastric emptying scintigraphy done through a standard semisolid meal (250 kcal), marked with 0.5 mCiTc 99, pre-operatively and 3 months after LSG. RESULTS The mean age was 38.71 years (9.2) and males comprised 57% of the cohort. The body mass index, low-density lipoproteins, and glycated hemoglobin declined significantly at 3-month postsurgery. The scintigraphy study revealed a significantly reduced percent retention at equivalent time points 3 months after LSG. In addition, the percent of patients suffering from GERD decreased significantly after LSG. CONCLUSION Gastric emptying becomes faster after LSG in morbidly obese non-diabetic patients. GERD symptoms improve after surgery.
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Affiliation(s)
| | | | - Ahmed Abdelsalam
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Abdallah
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam E Elshafey
- General Surgery Department, Faculty of Medicine, Helwan University, Helwan, Egypt
| | | | - Mahmoud Gouda Omar
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hesham Elkassar
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mohamed Atallah
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | | | - Zeinab Abdellatif
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shaimaa Elkholy
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Guzman-Pruneda FA, Brethauer SA. Gastroesophageal Reflux After Sleeve Gastrectomy. J Gastrointest Surg 2021; 25:542-550. [PMID: 32935271 DOI: 10.1007/s11605-020-04786-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/03/2020] [Indexed: 01/31/2023]
Abstract
Sleeve gastrectomy continues to be the most commonly performed bariatric operation worldwide. Development or worsening of pre-existing GERD has been recognized as a significant issue postoperatively. There is a paucity of information concerning the most appropriate preoperative workup and the technical and anatomical factors that may or may not contribute to the occurrence of reflux symptoms. Contemporary data quality is deficient given the predominantly retrospective nature, limited follow-up time, and heterogeneous outcome measures across studies. This has produced mixed results regarding the postoperative incidence and severity of GERD. Ultimately, better-constructed investigations are needed in order to offer evidence-based recommendations that may guide preoperative workup and improved patient selection criteria.
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Affiliation(s)
- Francisco A Guzman-Pruneda
- Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stacy A Brethauer
- Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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18
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Felinska E, Billeter A, Nickel F, Contin P, Berlth F, Chand B, Grimminger P, Mikami D, Schoppmann SF, Müller-Stich B. Do we understand the pathophysiology of GERD after sleeve gastrectomy? Ann N Y Acad Sci 2020; 1482:26-35. [PMID: 32893342 DOI: 10.1111/nyas.14467] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022]
Abstract
Gastroesophageal reflux disease (GERD), a prevalent problem among obese individuals, is strongly associated with obesity and weight loss. Hence, bariatric surgery effectively improves GERD for many patients. Depending on the type of bariatric procedure, however, surgery can also worsen or even cause a new onset of GERD. As a consequence, GERD remains a relevant problem for many bariatric patients, and especially those who have undergone sleeve gastrectomy (SG). Affected patients report not only a decrease in physical functioning but also suffer from mental and emotional problems, resulting in poorer social functioning. The pathomechanism of GERD after SG is most likely multifactorial and triggered by the interaction of anatomical, physiological, and physical factors. Contributing factors include the shape of the sleeve, the extent of injury to the lower esophageal sphincter, and the presence of hiatal hernia. In order to successfully treat post-sleeve gastrectomy GERD, the cause of the problem must first be identified. Therapeutic approaches include lifestyle changes, medication, interventional treatment, and/or revisional surgery.
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Affiliation(s)
- Eleni Felinska
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Adrian Billeter
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Pietro Contin
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Felix Berlth
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Bipan Chand
- Department of Surgery, Loyola University, Chicago, Illinois
| | - Peter Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Dean Mikami
- Department of Surgery, John A. Burton School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Sebastian F Schoppmann
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Beat Müller-Stich
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
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19
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Kraljević M, Süsstrunk J, Köstler T, Lazaridis II, Zingg U, Delko T. Short or Long Biliopancreatic Limb Bypass as a Secondary Procedure After Failed Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 31:170-178. [PMID: 32705461 DOI: 10.1007/s11695-020-04868-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy (SG) may be associated with long-term problems such as insufficient weight loss or weight regain, persistence or relapse of comorbidities, and gastroesophageal reflux disease (GERD). This study analyzes the outcome of patients that underwent conversion of SG to a gastric bypass procedure. MATERIALS AND METHODS All patients that underwent conversion from SG to the following four different gastric bypass procedures were analyzed: short biliopancreatic limb (BPL) bypass types such as proximal Roux-en-Y gastric bypass (PRYGB) or type 2 distal Roux-en-Y gastric bypass (type 2 DRYGB) and long BPL types such as long BPL RYGB or one anastomosis gastric bypass (OAGB). RESULTS Between 2012 and 2016, 52 patients received the following revisional procedures after primary SG: proximal RYGB (n = 12, 23.1%), type 2 DRYGB (n = 8, 15.4%), long BPL RYGB (n = 20, 38.5%), and OAGB (n = 12, 23.1%). The long BPL type procedures (long BPL RYGB, OAGB) resulted in a significant long-term additional %EWL (33.8%; 33.2%) at 3 years. In the PRYGB, the effect lasted only for 2 years. In all patients with GERD and dysphagia as the dominant post-SG symptoms, the conversion to a bypass procedure resulted in the complete resolution of these. CONCLUSION In case of weight regain or insufficient weight loss after SG, revisional surgery with a long BPL should be considered. The OAGB provides effective additional weight loss, with low morbidity and malnutrition rates, respectively. Conversion to the malabsorptive long BPL RYGB with a total alimentary limb length below 400 cm should be avoided. Patients that suffer primarily from post-SG GERD or dysphagia should undergo conversion to PRYGB.
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Affiliation(s)
- Marko Kraljević
- Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, 4002, Basel, Switzerland
| | - Julian Süsstrunk
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Thomas Köstler
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Ioannis I Lazaridis
- Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, 4002, Basel, Switzerland
| | - Urs Zingg
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Tarik Delko
- Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, 4002, Basel, Switzerland.
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20
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Pilone V, Tramontano S, Renzulli M, Zulli C, Schiavo L. Gastroesophageal Reflux After Sleeve Gastrectomy: New Onset and Effect on Symptoms on a Prospective Evaluation. Obes Surg 2020; 29:3638-3645. [PMID: 31267475 DOI: 10.1007/s11695-019-04046-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is present in half of the obese candidates for bariatric surgery. Variability of symptoms and new onset of GERD are often debated. Prior studies have demonstrated that sleeve gastrectomy (SG) is associated with significant weight loss. OBJECTIVES We prospectively evaluated the effect of a standardized SG technique on GERD symptoms in 104 patients. METHODS All patients were surveyed on the presence of heartburn and/or regurgitation with a specific questionnaire (GERD-HRQL). Esophagogastroduodenoscopy (EGDS) was performed in the preoperative phase and after 12 months. RESULTS All patients completed a 12-month follow-up. In the preoperative phase, 27.9% presented GERD symptoms (29 cases), while endoscopic findings were observed in 19.2% (20 cases). Preoperative GERD was ameliorated/solved in 65.5% of cases. The mean value of the GERD-HRQL score was significantly lower in postoperative evaluation (33.8 vs 19.4; p < 0.05). At 12-month EGDS, esophagitis was present in 13.5%, and GERD-HRQL symptoms were recorded in 10.6%. Considering patients treated until December 2015 (group 1, 44 patients) and those treated after December 2015 (group 2, 60 patients), all new clinical and endoscopic GERD diagnoses were observed in group 1; the majority of unsolved GERD cases was present in Ggoup 1 (8 vs 2; p < 0.05). CONCLUSION Significant amelioration on preoperative GERD was confirmed after SG. New characteristics of reflux are emerging in SG patients, often asymptomatic. Standardization is necessary to define the real effect of SG on GERD.
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Affiliation(s)
- Vincenzo Pilone
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy.,General, Bariatric and Emergency Surgical Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Salvatore Tramontano
- General, Bariatric and Emergency Surgical Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy.
| | - Michele Renzulli
- General, Bariatric and Emergency Surgical Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Claudio Zulli
- Endoscopic Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Luigi Schiavo
- Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli", Naples, Italy.,IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy
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21
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Ashrafi D, Osland E, Memon MA. Bariatric surgery and gastroesophageal reflux disease. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:S11. [PMID: 32309415 PMCID: PMC7154328 DOI: 10.21037/atm.2019.09.15] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With the rapidly increasing prevalence of obesity globally, the practice of bariatric surgery is being adopted routinely to prevent the development of chronic conditions as well as some forms of cancers associated with obesity. Gastroesophageal reflux disease (GERD) is one of those chronic conditions. Furthermore, there is accumulating data that obesity is associated with complications related to longstanding GERD such as erosive esophagitis (EE), Barrett's esophagus (BE), and esophageal adenocarcinoma (EAC). Central obesity, rather than body mass index (BMI), appears to be more closely associated with these complications. It should be expected, therefore, that weight loss procedures should result in improvement in GERD symptoms and its associated complications. However, in reality the different bariatric surgical procedures have unpredictable effects on an established GERD and may even produce GERD symptoms for the very first time (de novo). In this review, we explore the literature studying the effects of bariatric surgical operations on GERD. Roux-en-Y gastric bypass appears to have the most beneficial effect on GERD. On the other hand, laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding (LAGB) are linked with long-term increased prevalence of GERD. We argue that GERD is an extremely important preoperative consideration for any patient undergoing bariatric surgery and therefore should be thoroughly investigated objectively (with 24-hour pH study and high-resolution manometry) to select the most suitable bariatric procedure for patients for their long-term success.
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Affiliation(s)
- Darius Ashrafi
- Mayne Medical School, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Emma Osland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Department of Human Movements and Nutrition, University of Queensland, Brisbane, Queensland, Australia
| | - Muhammed Ashraf Memon
- Mayne Medical School, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,School of Agricultural, Computational and Environmental Sciences, International Centre for Applied Climate Sciences and Centre for Health Sciences Research, University of Southern Queensland, Toowoomba, Queensland, Australia.,Sunnybank Obesity Centre South & East Queensland Surgery (SEQS), Sunnybank, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK
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22
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Omentopexy in Sleeve Gastrectomy Reduces Early Gastroesophageal Reflux Symptoms. Surg Laparosc Endosc Percutan Tech 2019; 29:155-161. [PMID: 30499891 DOI: 10.1097/sle.0000000000000597] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is one of the surgical procedures indicated in the treatment of obesity. The occurrence of gastroesophageal reflux (GER) in the postoperative period of this surgery is related to a reduction in the lower esophageal sphincter (LES) tone and the presence of gastric residual fundus (RF) associated with increased gastric intraluminal pressure. Fixation of the remaining gastric reservoir to the gastrosplenic and gastrocolic ligaments (omentopexy) has emerged as a technical option to avoid or decrease GER in the postoperative period of LSG. OBJECTIVE To evaluate the presence of GER symptoms, alterations in LES tone, and the presence of RF in obese subjects submitted to LSG with omentopexy. METHODS Twenty obese patients were submitted to LSG with omentopexy from July 2016 to July 2017 at the Hospital Unimed de Teresina, Brazil and was studied prospectively. Clinical evaluations, including a specific questionnaire (clinical score), upper digestive endoscopy and esophageal manometry, were performed preoperatively and on the 90th postoperative day. Contrast x-ray of the esophagus, stomach, and duodenum were performed after the 90th postoperative day. The Fischer exact test was used to evaluate the correlation between GER symptoms and changes in LES tone or the presence of RF. Analysis of variance was used to evaluate the correlation of GER symptoms with the 2 variables together. All analyses adopted a level of significance for α errors >5% (P-value <0.05). RESULTS The mean clinical score of GER reduced from 6.7 in the preoperative period to 2.7 in the postoperative period. By manometry, there were no significant changes in the LES tone with mean values of 26.04 and 27.07 mm Hg before and after the procedure. RF was identified in 3 cases by contrast radiology. There was no statistical correlation between the changes in the LES tone or the presence of RF with the increase in the clinical score of GER (in cases where this occurred), even when the variables were evaluated together. CONCLUSIONS LSG with omentopexy improved the clinical score of GER in most cases and did not cause significant changes in the LES tone. The presence of RF did not exacerbate the clinical score of GER.
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Nau P, Jackson HT, Aryaie A, Ibele A, Shouhed D, Lo Menzo E, Kurian M, Khaitan L. Surgical management of gastroesophageal reflux disease in the obese patient. Surg Endosc 2019; 34:450-457. [PMID: 31720811 DOI: 10.1007/s00464-019-07231-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/28/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) affects two thirds of the American population. Obesity is also a disease that affects two thirds of the population. The pathophysiology of reflux disease is reasonably understood, however, the degree to which obesity affects this disease remains poorly defined. Therefore the approach to GERD in the obese patient requires special attention and its own algorithm. METHODS A literature search was conducted to consolidate the current available literature on GERD and its management in the obese. In addition, the authors reviewed the literature and present expert opinion on controversial topics. RESULTS It is well established that GERD is increased in obesity and the pathophysiology is reviewed. Management options for GERD are discussed, with a focus on the obese population. Management strategies including fundoplication and gastric bypass are discussed. In addition, bariatric surgery in the setting of GERD is also reviewed. CONCLUSIONS Currently this is an extremely controversial topic and this white paper presents a strong review of the literature to help guide the management of this challenging disease in this population. Expert recommendations are given throughout the paper based upon the current available data.
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Affiliation(s)
- P Nau
- Department of Surgery, Carver College of Medicine, Iowa City, IA, USA
| | - H T Jackson
- George Washington School of Medicine and Life Sciences, Washington, DC, USA
| | - A Aryaie
- Department of Surgery, Texas Tech, Lubbock, TX, USA
| | - A Ibele
- University of Utah College of Medicine, Salt Lake City, UT, USA
| | - D Shouhed
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - E Lo Menzo
- Department of Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - M Kurian
- New York University School of Medicine, New York, NY, USA
| | - L Khaitan
- Cleveland Medical Center, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
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Hefler J, Dang J, Mocanu V, Switzer N, Birch DW, Karmali S. Concurrent bariatric surgery and paraesophageal hernia repair: an analysis of the Metabolic and Bariatric Surgery Association Quality Improvement Program (MBSAQIP) database. Surg Obes Relat Dis 2019; 15:1746-1754. [DOI: 10.1016/j.soard.2019.08.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/19/2019] [Accepted: 08/19/2019] [Indexed: 01/13/2023]
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Alhaj Saleh A, Janik MR, Mustafa RR, Alshehri M, Khan AH, Kalantar Motamedi SM, Rahim S, Patel I, Aryaie A, Abbas M, Rogula T, Khaitan L. Does Sleeve Shape Make a Difference in Outcomes? Obes Surg 2019; 28:1731-1737. [PMID: 29313277 DOI: 10.1007/s11695-017-3087-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is one of the most common procedures performed for weight loss. Many seek the "perfect sleeve" with the notion that the type of calibrating device affects sleeve shape, and this in turn will affect outcomes and complications. Two major concerns after SG are amount of weight loss and acid reflux. Our aim was to determine if the various calibration methods could impact sleeve shape and thereby allow for better outcomes of weight loss and reflux. METHODS A retrospective chart review was performed of 210 patients who underwent SG and had postoperative upper gastrointestinal (UGI) study from 2011 to 2015 in a single center by a single (fellowship-trained) bariatric surgeon. Data regarding demographics, calibrating devices and clinical outcomes at 1 year (weight loss and de novo acid reflux) were collected. UGIs were reviewed by two radiologists blinded to the clinical outcomes. Sleeve shape was classified according to a previously described classification as tubular, dumbbell, upper pouch, or lower pouch. The types of calibrating devices used to guide the sleeve size intraoperatively were endoscopy, large-bore orogastric tube, and fenestrated suction tube. RESULTS One hundred ninety-nine patients met inclusion criteria (11 had no esophagram). Demographics revealed age 45.76 ± 10.6 years, BMI 47 ± 8.6 kg/m2, and 82% female. Calibration devices used were endoscopic guidance (7.6%), large bore orogastric tube (41.4%), and fenestrated suction tube (50.5%). Sleeve shape was reported as 32.6% tubular, 20.6% dumbbell, 39.2% lower pouch, and 7.5% upper pouch (100% interrater reliability). No correlation was seen with type of calibration used. Of patients, 62.0% had > 50% excess weight loss at 1 year. Twenty-three percent of patients remained on PPI at 1 year (of which 43.3% did not have reflux preoperatively). The lower pouch shape showed a trend toward less reflux and more weight loss. CONCLUSION This study showed no clear association between uniformity of sleeve shape and the type of calibration device used. The study showed a trend toward decreased reflux and improved weight loss with the lower pouch shape, regardless of calibration device.
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Affiliation(s)
- Adel Alhaj Saleh
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA.
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, USA.
| | - Michal R Janik
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
- Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów, 04-141, Warszawa, Poland
| | - Rami R Mustafa
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Mohammed Alshehri
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Adil H Khan
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Seyed Mohammad Kalantar Motamedi
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Shiraz Rahim
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Indravadan Patel
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Amir Aryaie
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, USA
| | - Mujjahid Abbas
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Tomasz Rogula
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Leena Khaitan
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA.
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Bou Daher H, Sharara AI. Gastroesophageal reflux disease, obesity and laparoscopic sleeve gastrectomy: The burning questions. World J Gastroenterol 2019; 25:4805-4813. [PMID: 31543675 PMCID: PMC6737315 DOI: 10.3748/wjg.v25.i33.4805] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/03/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023] Open
Abstract
Obesity is a global health epidemic with considerable economic burden. Surgical solutions have become increasingly popular following technical advances leading to sustained efficacy and reduced risk. Sleeve gastrectomy accounts for almost half of all bariatric surgeries worldwide but concerns regarding its relationship with gastroesophageal reflux disease (GERD) has been a topic of debate. GERD, including erosive esophagitis, is highly prevalent in the obese population. The role of pre-operative endoscopy in bariatric surgery has been controversial. Two schools of thought exist on the matter, one that believes routine upper endoscopy before bariatric surgery is not warranted in the absence of symptoms and another that believes that symptoms are poor predictors of underlying esophageal pathology. This debate is particularly important considering the evidence for the association of laparoscopic sleeve gastrectomy (LSG) with de novo and/or worsening GERD compared to the less popular Roux-en-Y gastric bypass procedure. In this paper, we try to address 3 burning questions regarding the inter-relationship of obesity, GERD, and LSG: (1) What is the prevalence of GERD and erosive esophagitis in obese patients considered for bariatric surgery? (2) Is it necessary to perform an upper endoscopy in obese patients considered for bariatric surgery? And (3) What are the long-term effects of sleeve gastrectomy on GERD and should LSG be done in patients with pre-existing GERD?
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Affiliation(s)
- Halim Bou Daher
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Ala I Sharara
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
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Impact of Pyloric Injection of Magnesium Sulfate-Lidocaine Mixture on Postoperative Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy: a Randomized-Controlled Trial. Obes Surg 2019; 29:1614-1623. [DOI: 10.1007/s11695-019-03762-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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High-Amplitude Gastric Contractions following Laparoscopic Sleeve Gastrectomy. Case Rep Surg 2019; 2019:7457361. [PMID: 30805244 PMCID: PMC6360550 DOI: 10.1155/2019/7457361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/08/2019] [Indexed: 11/29/2022] Open
Abstract
A proportion of laparoscopic sleeve gastrectomy patients experience symptoms of regurgitation and epigastric pain postoperation. The appearance of gastric sleeve contractions has been documented but its implications have not been adequately investigated. This case describes a 61-year-old female following laparoscopic sleeve gastrectomy. The patient underwent high-resolution impedance esophageal manometry that identified compartmentalized pressurization leading to propagating contractions throughout the gastric sleeve. Combined treatment with calcium channel blockers and gastric sleeve dilation relieved all symptoms. This case highlights the application of high-resolution impedance esophageal manometry to assess motor function and bolus transit in patients following laparoscopic sleeve gastrectomy.
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Oliveira CMD, Nassif AT, Branco Filho AJ, Nassif LS, Wrubleski TDA, Cavassola AP, Pintan RV. Factibilidade da gastrectomia vertical aberta no Sistema Único de Saúde. Rev Col Bras Cir 2019; 46:e20192351. [DOI: 10.1590/0100-6991e-20192351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/22/2019] [Indexed: 01/02/2023] Open
Abstract
RESUMO Objetivo: analisar as características clínicas e epidemiológicas, as complicações pós-operatórias e a perda de peso em pacientes submetidos à gastrectomia vertical por via convencional, em uma instituição de saúde do Sistema Único de Saúde (SUS). Métodos: estudo transversal, longitudinal, retrospectivo realizado a partir da coleta de dados de prontuários para análise de variáveis em pacientes submetidos à gastrectomia vertical aberta, no SUS, no período de julho de 2013 a janeiro de 2017. Resultados: foram analisados 296 pacientes operados no período do estudo, dos quais 54% eram do sexo masculino; a média de idade foi de 39,9 anos ±11,4; o índice de massa corporal (IMC) médio no pré-operatório foi de 43,5kg/m² e no pós-operatório, de 30,3kg/m²; a perda de excesso de peso foi de 73,6%; 83,24% apresentaram uma perda de excesso de peso maior do que 50%; o IMC pré-operatório foi maior no grupo com perda de peso menor do que 50%. Observou-se uma taxa de complicações precoces com necessidade de internamento de 5,4% e um índice de mortalidade de 1%. Conclusão: a gastrectomia vertical aberta é uma técnica segura e eficaz para a perda de peso e que pode ser mais realizada no SUS. Dentre as variáveis avaliadas, o IMC prévio foi a única relacionada com o sucesso pós-operatório.
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Rayman S, Goldenshluger M, Goitein O, Dux J, Sakran N, Raziel A, Goitein D. Conversion for failed adjustable gastric banding warrants hiatal scrutiny for hiatal hernia. Surg Endosc 2018; 33:2231-2234. [PMID: 30341651 DOI: 10.1007/s00464-018-6509-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/11/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Failure or complications following laparoscopic adjustable gastric banding (LAGB) may necessitate band removal and conversional surgery. Band position and band-induced chronic vomiting create ideal conditions for de novo hiatal hernia (HH) formation. HH presence impedes and complicates conversional surgery by obscuring crucial anatomical landmarks and hindering precise gastric sleeve or pouch formation. The aim of this study was to evaluate the incidence of a HH in patients with an LAGB undergoing conversion compared to patients undergoing primary bariatric surgery (BS). METHODS Retrospective review of consecutive BS performed between 2010 and 2015. Data collected included demographics, anthropometrics, comorbidities, previous BS, preoperative and intra-operative HH detection, operation time, perioperative complications and length of hospital stay. RESULTS During the study period, 2843 patients (36% males) underwent BS. Of these, 2615 patients (92%) were "primary" (no previous BS-control group), 197 (7%) had a previous LAGB (study group), and 31 (1%) had a different previous BS and were excluded. Reasons for conversion included weight regain, band intolerance and band-related complications. Mean age and body mass index were similar between the study and the control groups. HH was preoperatively diagnosed by upper gastrointestinal (UGI) fluoroscopy in 9.1% and 9.0% of the LAGB and control groups (p = NS), respectively. However, HH was detected intra-operatively in 20.3% and 7.3%, respectively (p < 0.0001). CONCLUSIONS Preoperative diagnosis of a HH by UGI fluoroscopy for patients who have undergone LAGB is unreliable. Intra-operative hiatal exploration is highly recommended in all cases of conversional BS after LAGB.
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Affiliation(s)
- Shlomi Rayman
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Goldenshluger
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orly Goitein
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Dux
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
- Department of Surgery A, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Asnat Raziel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - David Goitein
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel.
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
PURPOSE OF REVIEW Bariatric surgery is the best therapeutic approach to patients with morbid obesity, but there is mounting evidence that it is associated with esophageal dysfunctions, including gastroesophageal reflux disease (GERD) and motor disorders. In the present review, we summarize the existing information on the complex link between bariatric surgery and esophageal disorders. RECENT FINDINGS Although high-quality studies on these effects are lacking, because of evident methodological flaws and retrospective nature, the review of published investigations show that pure restrictive procedures, such as laparoscopic adjustable gastric banding (LAPG) and laparoscopic sleeve gastrectomy (LSG), are associated with de novo development or worsening of GERD. Moreover, LAGB is the procedure with the greatest frequency of esophageal motor disorders, including impairment of LES relaxation and ineffective esophageal peristalsis associated with esophageal dilation. LSG seems to be less associated with esophageal dysmotility, although evidence derived from studies with objective measurements of esophageal dysfunction is limited. Finally, RYGB seems to be the best procedure for improvement of GERD symptoms and preservation of esophageal function. SUMMARY Overall, the restrictive-malabsorptive approach represented by RYGB must be preferred to pure restrictive operations in order to avoid the negative consequences of bariatric surgery on esophageal functions.
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An Algorithmic Approach to the Management of Gastric Stenosis Following Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 27:2628-2636. [PMID: 28470488 DOI: 10.1007/s11695-017-2689-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastric stenosis (GS) is a potential adverse event post-laparoscopic sleeve gastrectomy (LSG). Endoscopic management is preferred; however, there is significant variation in therapeutic strategies with no defined algorithm. This study aims to describe the safety and efficacy of a predefined step-wise algorithm for endoscopic management of GS post-LSG. METHODS Consecutive patients with symptomatic GS post-LSG, presenting between July 2015 and August 2016, were subjected to a predefined treatment algorithm of serial dilations using achalasia balloons, followed by a fully covered self-expanding metal stent (FCSEMS) if dilations were inadequate. Patients who did not respond or opted out of ongoing endoscopic therapy were offered revision Roux-en-Y gastric bypass (RYGB). RESULTS Total of 17 patients underwent a median of 2 (range 1-4) balloon dilations. Twelve patients (70.6%) reported clinical improvement with balloon dilation alone, while 3 (17.6%) required subsequent FCSEMS placement. One patient suffered a tear to the muscularis propria with balloon dilation, which was managed conservatively. Overall, 15 (88.2%) reported clinical improvement with endoscopic management. PAGI-SYM scores revealed that the strongest response to therapy, based on mean reduction of score ± SD, was in the following items: nausea (3 ± 1.9, P < 0.001), heartburn during day (2.8 ± 1.5, P = 0.003), heartburn on lying down (3.4 ± 1.4, P < 0.001), reflux during day (2.8 ± 1.9, P < 0.001), and reflux on lying down (3.0 ± 1.9, P < 0.001). Two (11.8%) patients failed endoscopic therapy and underwent RYGB. CONCLUSIONS Endoscopic management of GS using the described algorithmic approach is safe and effective post-LSG. Patients with severe stenosis or helical stenosis are likely to require revision RYGB.
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McGlone ER, Gupta AK, Reddy M, Khan OA. Antral resection versus antral preservation during laparoscopic sleeve gastrectomy for severe obesity: Systematic review and meta-analysis. Surg Obes Relat Dis 2018; 14:857-864. [PMID: 29602713 DOI: 10.1016/j.soard.2018.02.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 11/24/2022]
Abstract
Although laparoscopic sleeve gastrectomy is an established operation for severe obesity, there is controversy regarding the extent to which the antrum is excised. The objective of this systematic review was to investigate the effect on perioperative complications and medium-term outcomes of antral resecting versus antral preserving sleeve gastrectomy. MEDLINE, EMBASE, and Cochrane databases were searched from 1946 to April 2017. Eligible studies compared antral resection (staple line commencing 2-3 cm from pylorus) with antral preservation (>5 cm from pylorus) in patients undergoing primary sleeve gastrectomy for obesity. Meta-analyses were performed with a random-effects model, and risk of bias within and across studies was assessed using validated scoring systems. Eight studies (619 participants) were included: 6 randomized controlled trials and 2 cohort studies. Overall follow-up was 94% for the specified outcomes of each study. Mean percentage excess weight loss was 62% at 12 months (7 studies; 574 patients) and 67% at 24 months (4 studies; 412 patients). Antral resection was associated with significant improvement in percentage excess weight loss at 24-month follow-up (mean 70% versus 61%; standardized mean difference .95; confidence interval .35-1.58, P<.005), an effect that remained significant when cohort studies were excluded. There was no difference in incidence of perioperative bleeding, leak, or de novo gastroesophageal reflux disease. According to the available evidence, antral resection is associated with better medium-term weight loss compared with antral preservation, without increased risk of surgical complications. Further randomized clinical trials are indicated to confirm this finding.
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Affiliation(s)
- Emma Rose McGlone
- Department of Metabolic and Investigative Medicine, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom.
| | - Ajay K Gupta
- Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Marcus Reddy
- Department of Upper Gastrointestinal and Bariatric Surgery, St George's Hospital, London, United Kingdom; Department of Upper GI and Bariatrics, Hebei Medical University, Shijiazhuang, China
| | - Omar A Khan
- Department of Upper Gastrointestinal and Bariatric Surgery, St George's Hospital, London, United Kingdom; Population Health Research Institute, St George's, University of London, London, United Kingdom
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Soricelli E, Casella G, Baglio G, Maselli R, Ernesti I, Genco A. Lack of correlation between gastroesophageal reflux disease symptoms and esophageal lesions after sleeve gastrectomy. Surg Obes Relat Dis 2018; 14:751-756. [PMID: 29571635 DOI: 10.1016/j.soard.2018.02.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/12/2018] [Accepted: 02/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The postoperative development or worsening of gastroesophageal reflux disease (GERD) represents the major drawback of laparoscopic sleeve gastrectomy (SG). A GERD diagnosis is often based only on symptoms and proton pump inhibitors (PPI) intake, while objective tests like esophagogastroduodenoscopy and pH measurements are performed less frequently. OBJECTIVES To evaluate the association between reflux symptoms and GERD-related esophageal lesions. SETTINGS University hospital, Rome, Italy. METHODS A comprehensive clinical control entailing GERD symptoms, PPI intake, and esophagogastroduodenoscopy was proposed to all patients who underwent SG between June 2007 and February 2011, irrespective of the presence of GERD symptoms. One hundred forty-four of 219 patients agreed to take part in the study (follow-up rate: 65.8%). RESULTS After a mean follow-up of 66 months, GERD symptoms and PPI intake were recorded in 70.2% and 63.9% of patients, respectively. Mean visual analogue scale score was 2.9 ± 3.3. The overall frequency of erosive esophagitis was 59.8%, while nondysplastic Barrett's esophagus was detected in 13.1%. The frequency of esophageal biliary reflux was 68%. GERD symptoms and visual analogue scale score were not significantly associated with the development of erosive esophagitis and Barrett's esophagus and the severity of the esophageal lesions. Moreover, the frequency of erosive esophagitis and Barrett's esophagus in patients consuming PPI were similar to that of patients without PPI. CONCLUSION Symptoms investigation alone is not a reliable tool to diagnose GERD after SG. The use of objective diagnostic tests, such as esophagogastroduodenoscopy, should be carefully considered in the postoperative follow-up schedule of SG patients.
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Affiliation(s)
- Emanuele Soricelli
- Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
| | - Giovanni Casella
- Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Roberta Maselli
- Endoscopic unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ilaria Ernesti
- Department of Experimental Medicine-Medical Physiopathology, Food Science and Endocrinology Section, Sapienza University of Rome, Rome, Italy
| | - Alfredo Genco
- Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Dakour Aridi H, Asali M, Fouani T, Alami RS, Safadi BY. Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair: an Unresolved Question. Obes Surg 2017; 27:2898-2904. [DOI: 10.1007/s11695-017-2702-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Rebecchi F, Allaix ME, Patti MG, Schlottmann F, Morino M. Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve? World J Gastroenterol 2017; 23:2269-2275. [PMID: 28428706 PMCID: PMC5385393 DOI: 10.3748/wjg.v23.i13.2269] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/15/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic sleeve gastrectomy (LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease (GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h pH monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve (both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Roux-en-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX® Reflux Management System procedure and the Stretta® procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of pH monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5th International Consensus Conference on sleeve gastrectomy.
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Saber AA, Shoar S, Khoursheed M. Intra-thoracic Sleeve Migration (ITSM): an Underreported Phenomenon After Laparoscopic Sleeve Gastrectomy. Obes Surg 2017; 27:1917-1923. [DOI: 10.1007/s11695-017-2589-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Nath A, Yewale S, Tran T, Brebbia JS, Shope TR, Koch TR. Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention. World J Gastroenterol 2016; 22:10371-10379. [PMID: 28058017 PMCID: PMC5175249 DOI: 10.3748/wjg.v22.i47.10371] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/09/2016] [Accepted: 11/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy (VSG).
METHODS VSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single institution study of consecutive patients who underwent sleeve gastrectomy from 2013 to 2015. Patients with previous bariatric procedures were excluded. Narrowing of a gastric sleeve includes: inability to pass a 9.6 mm gastroscope due to stenosis or sharp angulation or spiral hindering its passage.
RESULTS Of 400 consecutive patients, 352 are included; the prevalence of dysphagia is 22.7%; 33 patients (9.3%) have narrowing of the sleeve with 25 (7.1%) having sharp angulation or a spiral while 8 (2.3%) have a stenosis. All 33 patients underwent balloon dilatation of the gastric sleeve and dysphagia resolved in 13 patients (39%); 10 patients (30%) noted resolution of dysphagia after two additional dilatations. In a multivariate model, medical conditions associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, a low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids.
CONCLUSION Narrowing of the gastric sleeve and gastric sleeve stenosis are common after VSG. Endoscopic balloon dilatations of the gastric sleeve resolves dysphagia in 69% of patients.
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Hawasli A, Tarakji M, Tarboush M. Laparoscopic management of severe reflux after sleeve gastrectomy using the LINX ® system: Technique and one year follow up case report. Int J Surg Case Rep 2016; 30:148-151. [PMID: 28012332 PMCID: PMC5192038 DOI: 10.1016/j.ijscr.2016.11.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/26/2016] [Accepted: 11/27/2016] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Management of severe reflux after sleeve gastrectomy (SG) usually requires converting to Roux-en-y gastric bypass (RYGB). We present a case of managing this problem using the LINX® system. PRESENTATION OF CASE In February 2015, we performed a laparoscopic placement of LINX® system to treat severe reflux after sleeve gastrectomy on a 25-year-old female. The operative time was 47min. There were no intra or postoperative complications. The hospital stay was one day. The postoperative UGI showed no reflux. Ten days after surgery her Quality of life score (QOL) changed from 64/75 to 7/75 after the LINX® placement. One year later the patient continued to enjoy no reflux and stayed off medication. DISCUSSION Reflux after sleeve gastrectomy is usually managed by conversion to RYGB by most surgeons. This case report opens the door for an alternative management of this problem while maintaining the original sleeve gastrectomy. This technique is reasonably easy to perform in comparison to the conversion to RYGB with less potential post-operative complications. A one year follow up showed good control of reflux without medication. CONCLUSION Laparoscopic placement of the LINX® system to correct severe reflux after sleeve gastrectomy is a safe alternative procedure to conversion to a RYGB.
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Affiliation(s)
- Abdelkader Hawasli
- Department of Minimally Invasive Surgery, St. John Hospital & Medical Center, Detroit, MI, United States.
| | - Mark Tarakji
- Department of Minimally Invasive Surgery, St. John Hospital & Medical Center, Detroit, MI, United States
| | - Moayad Tarboush
- Department of Minimally Invasive Surgery, St. John Hospital & Medical Center, Detroit, MI, United States
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Abstract
BACKGROUND The appearance and incidence of gastroesophageal reflux after sleeve gastrectomy is not yet resolved, and there is an important controversy in the literature. No publications regarding the appearance of Barrett's esophagus after sleeve gastrectomy are present in the current literature. PURPOSE The purpose of this paper was to report the incidence of Barrett's esophagus in patients submitted to sleeve. MATERIAL AND METHODS Two hundred thirty-one patients are included in this study who were submitted to sleeve gastrectomy for morbid obesity. None had Barrett's esophagus. Postoperative upper endoscopy control was routinely performed 1 month after surgery and 1 year after the operation, all completed the follow-up in the first year, 188 in the second year, 123 in the third year, 108 in the fifth year, and 66 patients over 5 years after surgery. RESULTS Among 231 patients operated on and followed clinically, reflux symptoms were detected in 57 (23.2%). Erosive esophagitis was found in 38 patients (15.5%), and histological examination confirmed Barrett's esophagus in 3/231 cases (1.2%) with presence of intestinal metaplasia. CONCLUSION Bariatric surgeons should be aware of the association of gastroesophageal reflux (GER) disease and obesity. Appropriate bariatric surgery should be indicated in order to prevent the occurrence of esophagitis and Barrett's esophagus.
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Li J, Lai D, Wu D. Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy to Treat Morbid Obesity-Related Comorbidities: a Systematic Review and Meta-analysis. Obes Surg 2016; 26:429-42. [PMID: 26661105 DOI: 10.1007/s11695-015-1996-9] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Our aim was to compare laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) for treating morbid obesity and its related comorbidities. An electronic literature search was performed from inception to May 2015 and a total of 18,455 patients, enrolled in 62 recent studies, were included in this meta-analysis. Patients receiving LRYGB had a significantly higher percentage of excess weight loss and better resolution of hypertension, dyslipidemia, gastroesophageal reflux disease, and arthritis compared with those receiving LSG. LRYGB and LSG showed similar effects on type 2 diabetes mellitus and sleep apnea.
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Affiliation(s)
- Jianfang Li
- Department of Gastrointestinal Surgery, The First People's Hospital of Xiaoshan, No. 199 Shixinnan Road, Hangzhou, Zhejiang Province, 311200, China.
| | - Dandan Lai
- Department of Gastrointestinal Surgery, The First People's Hospital of Xiaoshan, No. 199 Shixinnan Road, Hangzhou, Zhejiang Province, 311200, China
| | - Dongping Wu
- Department of Gastrointestinal Surgery, The First People's Hospital of Xiaoshan, No. 199 Shixinnan Road, Hangzhou, Zhejiang Province, 311200, China
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Crawford C, Gibbens K, Lomelin D, Krause C, Simorov A, Oleynikov D. Sleeve gastrectomy and anti-reflux procedures. Surg Endosc 2016; 31:1012-1021. [PMID: 27440196 DOI: 10.1007/s00464-016-5092-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/05/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Obesity is an epidemic in the USA that continues to grow, becoming a leading cause of premature avoidable death. Bariatric surgery has become an effective solution for obesity and its comorbidities, and one of the most commonly utilized procedures, the sleeve gastrectomy, can lead to an increase in gastroesophageal reflux following the operation. While these data are controversial, sometimes operative intervention can be necessary to provide durable relief for this problem. METHODS We performed an extensive literature review examining the different methods of anti-reflux procedures that are available both before and after a sleeve gastrectomy. RESULTS We reviewed several different types of anti-reflux procedures, including those that supplement the lower esophageal sphincter anatomy, such as magnetic sphincter augmentation and radiofrequency ablation procedures. Re-operation was also discussed as a possible treatment of reflux in sleeve gastrectomy, especially if the original sleeve becomes dilated or if a conversion to a Roux-en-Y gastric bypass or biliopancreatic diversion is deemed necessary. Sleeve gastrectomy with concomitant anti-reflux procedure was also reviewed, including the anti-reflux gastroplasty, hiatal hernia repair, and limited fundoplication. CONCLUSION A number of techniques can be used to mitigate the severity of reflux, either by maintaining the normal anatomic structures that limit reflux or by supplementing these structures with a plication or gastroplasty. Individuals with existing severe reflux should not be considered for a sleeve gastrectomy. New techniques that incorporate plication at the time of the index sleeve gastrectomy show some improvement, but these are in small series that will need to be further evaluated. The only proven method of treating intractable reflux after sleeve gastrectomy is conversion to a Roux-en-Y gastric bypass.
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Affiliation(s)
- Christopher Crawford
- Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA
| | - Kyle Gibbens
- College of Medicine, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE, 68198-5520, USA
| | - Daniel Lomelin
- Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA
| | - Crystal Krause
- Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA
| | - Anton Simorov
- Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA
| | - Dmitry Oleynikov
- Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA.
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A Case Study of Severe Esophageal Dysmotility following Laparoscopic Sleeve Gastrectomy. Case Rep Surg 2016; 2016:9363545. [PMID: 27413570 PMCID: PMC4930820 DOI: 10.1155/2016/9363545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/29/2016] [Indexed: 12/19/2022] Open
Abstract
Following bariatric surgery, a proportion of patients have been observed to experience reflux, dysphagia, and/or odynophagia. The etiology of this constellation of symptoms has not been systematically studied to date. This case describes a 36-year-old female with severe esophageal dysmotility following LSG. Many treatments had been used over a course of 3 years, and while calcium channel blockers reversed the esophageal dysmotility seen on manometry, significant symptoms of dysphagia persisted. Subsequently, the patient underwent a gastric bypass, which seemed to partially relieve her symptoms. Her dysphagia was no longer considered to be associated with a structural cause but attributed to a “sleeve dysmotility syndrome.” Considering the difficulties with managing sleeve dysmotility syndrome, it is reasonable to consider the need for preoperative testing. The question is whether motility studies should be required for all patients planning to undergo a LSG to rule out preexisting esophageal dysmotility and whether conversion to gastric bypass is the preferred method for managing esophageal dysmotility after LSG.
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Khan A, Kim A, Sanossian C, Francois F. Impact of obesity treatment on gastroesophageal reflux disease. World J Gastroenterol 2016; 22:1627-1638. [PMID: 26819528 PMCID: PMC4721994 DOI: 10.3748/wjg.v22.i4.1627] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/14/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is a frequently encountered disorder. Obesity is an important risk factor for GERD, and there are several pathophysiologic mechanisms linking the two conditions. For obese patients with GERD, much of the treatment effort is focused on weight loss and its consistent benefit to symptoms, while there is a relative lack of evidence regarding outcomes after novel or even standard medical therapy is offered to this population. Physicians are hesitant to recommend operative anti-reflux therapy to obese patients due to the potentially higher risks and decreased efficacy, and these patients instead are often considered for bariatric surgery. Bariatric surgical approaches are broadening, and each technique has emerging evidence regarding its effect on both the risk and outcome of GERD. Furthermore, combined anti-reflux and bariatric options are now being offered to obese patients with GERD. However, currently Roux-en-Y gastric bypass remains the most effective surgical treatment option in this population, due to its consistent benefits in both weight loss and GERD itself. This article aims to review the impact of both conservative and aggressive approaches of obesity treatment on GERD.
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Ng JY, Cheng AKS, Kim G, Kong LWC, Soe KT, Lomanto D, So JBY, Shabbir A. Is Elective Gastroscopy Prior to Bariatric Surgery in an Asian Cohort Worthwhile? Obes Surg 2016; 26:2156-2160. [DOI: 10.1007/s11695-016-2060-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Nett PC, Kröll D, Borbély Y. Re-sleeve gastrectomy as revisional bariatric procedure after biliopancreatic diversion with duodenal switch. Surg Endosc 2016; 30:3511-5. [DOI: 10.1007/s00464-015-4640-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 10/22/2015] [Indexed: 12/25/2022]
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Hendricks L, Alvarenga E, Dhanabalsamy N, Lo Menzo E, Szomstein S, Rosenthal R. Impact of sleeve gastrectomy on gastroesophageal reflux disease in a morbidly obese population undergoing bariatric surgery. Surg Obes Relat Dis 2015; 12:511-517. [PMID: 26792456 DOI: 10.1016/j.soard.2015.08.507] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/27/2015] [Accepted: 08/24/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has established popularity as a weight loss procedure based on its success. However, LSG's effect on gastroesophageal reflux disease (GERD) is unknown. OBJECTIVES To analyze the incidence of GERD after LSG and to compare the results in patients with preexisting and de novo GERD. SETTING Tertiary Medical center. METHODS The authors performed a retrospective review of primary LSG from 2005 to 2013 and compared patients with pre-existing and de novo GERD who underwent LSG. RESULTS A total of 919 patients underwent LSG. GERD was present in 38 (4%) of the LSG cohort. We identified 2 groups: Group A consisted of 25 (3%) patients with de novo GERD, and Group B consisted of 13 (1%) patients with pre-existing GERD. Diagnosis of GERD in both groups was determined by symptoms and history of proton pump inhibitor (PPI) treatment, upper gastrointestinal endoscopy, esophagogastroduodenoscopy, and pH manometry. In Group A, 1 (4%) patient was managed with over-the-counter drugs, 17 (68%) patients were treated with low-dose PPI, 6 (24%) patients were treated with high-dose PPI, and 1 (4%) patient was lost to follow-up. Group B consisted of 9 (69%) patients treated with low-dose PPI and 4 (31%) patients treated with high-dose PPI. Medical treatment failed in 4 patients (10.5%) who subsequently required conversion to laparoscopic Roux-en-Y gastric bypass (LRYGB). In Group A, 1 patient (4%) required LRYGB, and in Group B, 3 patients (23%) required LRYGB. The outcome of conversion for Group A was incomplete resolution of symptoms in the 1 patient, whereas in Group B, all 3 patients (100%) had complete resolution of GERD symptoms after LRYGB. CONCLUSIONS In this study, 3% of patients developed de novo GERD, but most responded to either low- or high-dose PPI, with 4% requiring conversion to LRYGB.
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Affiliation(s)
- LéShon Hendricks
- The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Emanuela Alvarenga
- The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Nisha Dhanabalsamy
- The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Raul Rosenthal
- The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, Florida.
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Kim SB, Kim KK, Chung JW, Kim SM. Initial Experiences of Laparoscopic Gastric Greater Curvature Plication in Korea-A Review of 64 Cases. J Laparoendosc Adv Surg Tech A 2015; 25:793-9. [PMID: 26389582 DOI: 10.1089/lap.2015.0164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Laparoscopic gastric greater curvature plication (LGGCP) is an emerging, alternative form of restrictive weight loss surgery. We present our experiences of LGGCP with the primary focus on surgical techniques and weight loss. In addition, an investigation was performed on the food tolerance of LGGCP patients. MATERIALS AND METHODS This study was conducted by retrospectively reviewing the prospectively collected data of patients who underwent LGGCP from March 2013 to February 2015. RESULTS Of the 64 patients were eligible for the study, 59 (92.2%) were female. Mean (range) patient age was 34 (21-49) years. Mean ± standard deviation (SD) preoperative body mass index was 31.4 ± 4.3 kg/m(2). There were no mortalities or postoperative complications. Immediate postoperative nausea and vomiting occurred in 58 patients (90.6%), mean postoperative hospital stay duration was 2.3 days (range, 1-7 days), and mean percentage excess body mass index losses at 1, 3, 6, 12, and 18 months were 34.7% (n = 64), 50.8% (n = 60), 61.1% (n = 40), 82.1% (n = 19), and 82.9% (n = 12), respectively. Follow-up endoscopy was performed at 12 months postoperatively in 19 patients, and reflux esophagitis of grade LA-M was observed in 16 patients (84.2%), LA-A in 2 patients (10.5%), and LA-B in 1 patient (5.3%). Mean ± SD satisfaction score with current eating and total food tolerance score was 4.27 ± 0.55 and 20.95 ± 4.30, respectively. CONCLUSIONS LGGCP is an intervention that may be comparable with sleeve gastrectomy or adjustable gastric banding, especially for Class I or II obesity in an Asian population. Furthermore, quality of eating, as determined using food tolerance scores, was excellent.
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Affiliation(s)
- Su Bin Kim
- 1 Department of Surgery, Gil Medical Center, Gachon University College of Medicine , Incheon, Republic of Korea
| | - Kyoung Kon Kim
- 2 Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine , Incheon, Republic of Korea
| | - Jun Won Chung
- 3 Division of Gastroenterology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine , Incheon, Republic of Korea
| | - Seong Min Kim
- 1 Department of Surgery, Gil Medical Center, Gachon University College of Medicine , Incheon, Republic of Korea
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Burgerhart JS, van Rutte PWJ, Edelbroek MAL, Wyndaele DNJ, Smulders JF, van de Meeberg PC, Siersema PD, Smout AJPM. Association between postprandial symptoms and gastric emptying after sleeve gastrectomy. Obes Surg 2015; 25:209-14. [PMID: 25217397 DOI: 10.1007/s11695-014-1410-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure. However, postprandial symptoms can compromise its beneficial effect. It is not known if a changed gastric emptying and these symptoms are related. This study aimed to assess the association between postprandial symptoms and the gastric emptying pattern after LSG. METHODS A gastric emptying study with a solid and liquid meal component was performed in the second year after LSG. Before the test, symptoms were assessed using a standardized questionnaire, and during the test, symptoms were scored on a visual analog scale (VAS). Gastric emptying results were expressed as lag phase, half time of gastric emptying (T½), and caloric emptying rate/minute. RESULTS Twenty patients (14 F/6 M; age 45.6 ± 7.7 years, weight 93.4 ± 28.2 kg, BMI 31.6 ± 8.1 kg/m(2)) participated in this study; 13 had a low symptom score (≤9, group I), 7 a high symptom score (≥18, group II). VAS scores for epigastric pain, nausea, and belching were significantly higher in group II. Lag phase (solid) was 6.4 ± 4.5 min in group I, 7.3 ± 6.3 in group II (p = 0.94); T½ (solid) was 40.6 ± 10.0 min in group I, 34.4 ± 9.3 in group II (p = 0.27); caloric emptying rate was 3.9 ± 0.6 kcal/min in group I, 3.9 ± 1.0 kcal/min in group II (p = 0.32). CONCLUSIONS Patients with postprandial symptoms after LSG reported more symptoms during the gastric emptying study than patients without symptoms. However, there was no difference between gastric emptying characteristics between both groups, suggesting that abnormal gastric emptying is not a major determinant of postprandial symptoms after LSG.
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Affiliation(s)
- Jan S Burgerhart
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands,
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Meredith I, Lim YK, Wickremesekera SK, Bann S. Experience of imaging following laparoscopic sleeve gastrectomy. ANZ J Surg 2015; 86:568-71. [PMID: 26333708 DOI: 10.1111/ans.13284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND We aimed to report our experience with upper gastrointestinal (UGI) contrast studies and computed tomography (CT) swallow studies after laparoscopic sleeve gastrectomy, and comment on the merits of each modality. METHOD Retrospective review of all patients undergoing laparoscopic sleeve gastrectomy (LSG) in a New Zealand hospital between 2011 and 2014 was conducted. Over this time period, routine UGI was replaced by CT swallow studies. All medical records and radiology were reviewed and pertinent findings reported. RESULTS Seventy-nine patients underwent LSG over this time period and one patient had to be excluded; 48 (61.5%) had a UGI study and 30 patients (38.5%) had CT swallow. There were no leaks in this study and no leaks became clinically significant. Sixteen of 30 patients (53.3%) undergoing CT swallow had significant incidental findings demonstrated on axial imaging that required follow-up. CONCLUSION CT swallow can provide the same information as a UGI but has a significant rate of incidental findings. The rate of incidental pathology on CT is higher than that quoted in the general population. In a bariatric population, this may allow early detection and treatment of co-existent pathology.
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Affiliation(s)
- Ineke Meredith
- Department of General Surgery, North Shore Hospital, Auckland, New Zealand.,Wellington School of Medicine, University of Otago, Wellington, New Zealand
| | - Yu Kai Lim
- Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand
| | | | - Simon Bann
- Wellington School of Medicine, University of Otago, Wellington, New Zealand.,Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand.,Victoria University, Wellington, New Zealand
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