Sleeve gastrectomy (SG) is a common common bariatric procedure. There is growing concern about the development of gastroesophageal reflux disease (GERD) and Barretts esophagus following SG. Endoscopic screening prior to bariatric surgery is still debated. Therefore, Bellorin and colleagues conducted a study to assess the preoperative endoscopic factors that may help predict the development of GERD following SG.

This prospective study assessed 217 patients undergoing primary robotic-assisted SG. Patients were subjected to endoscopy prior to SG and for-cause after surgery. Researchers followed the patients for the development of GERD, confirmed either by biopsy-proven reflux esophagitis or a positive esophageal pH test. Based on the development of GERD following SG, the patients were divided into 2 groups: Those who developed GERD (GERD group) and those who did not (No GERD group). Exclusion criteria included patients with a positive preoperative pH test, LA Grade B or greater esophagitis, or hiatal hernia > 5 cm on preoperative endoscopy.

• There were 25.6% males in the No GERD group compared to 8.1% in the GERD group (p = 0.02).
• About 40.5% of the patients in the GERD group had preoperative symptoms of heartburn (vs. 23.9%; p = 0.04).
• Endoscopically confirmed esophagitis was more frequently reported in the GERD group (29.7% vs. 13.3%; p = 0.01). The same was true for biopsy-proven esophagitis (24.3% vs. 11.1%; p = 0.03).
• No significant difference was evident in the incidence or size of hiatal hernia or rate of H. pylori infection between the two groups.
• Multivariate analysis revealed that the most robust predictors of GERD after surgery included endoscopically confirmed esophagitis (odds ratio [OR] 2.79; 95% confidence interval [CI] 1.17-6.69; p = 0.02) and biopsy-proven esophagitis (OR 2.80; 95% CI 1.06-7.37; p = 0.04).
• Male patients had a lesser preponderance to develop GERD after SG (OR 0.23; 95% CI 0.06-0.85; p = 0.03).

The study reinforces the consideration of routine preoperative endoscopy and underscores the clinical and endoscopic criteria that must urge physicians to consider alternatives to SG.

Source: Bellorin O, Senturk JC, Cruz MV, et al. Predictive Factors for Developing GERD After Sleeve Gastrectomy: Is Preoperative Endoscopy Necessary? J Gastrointest Surg. 2022 Jan 8