Genco Alfredo, Soricelli Emanuele, Casella Giovanni, Maselli Roberta, Castagneto-Gissey Lidia, Di Lorenzo Nicola, Basso Nicola
Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Surg Obes Relat Dis. 2017 Apr;13(4):568-574. doi: 10.1016/j.soard.2016.11.029. Epub 2016 Dec 9.
Morbidly obese patients are affected by gastroesophageal reflux disease (GERD) and hiatal hernia (HH) more frequently than lean patients. Because of conflicting results, the indication to sleeve gastrectomy (SG) in patients with GERD is still debated.
To evaluate the incidence of GERD on the basis of clinical, endoscopic, and histologic data in patients undergoing SG.
University hospital, Rome, Italy.
From July 2007 to January 2010, 162 patients underwent primary SG. Preoperatively all patients underwent visual analogue scale (VAS) evaluation of GERD symptoms, proton pump inhibitors (PPIs) consumption recording, and esophagogastroduodenoscopy (EGD). Stomach resection started 6 cm from pylorus on a 48Fr bougie. Staple line was reinforced by an oversewing suture. A postoperative clinical control with VAS evaluation, PPI consumption, and EGD was proposed to all patients. Three patients were excluded because of the occurrence of major postoperative complications.
A total of 110 patients accepted to take part in the study (follow-up rate: 69.1%). At a mean 58 months of follow-up, incidence of GERD symptoms, VAS mean score, and PPI intake significantly increased compared with preoperative values (68.1% versus 33.6%: P<.0001; 3 versus 1.8: P = .018; 57.2% versus 19.1%: P<.0001) At EGD, an upward migration of the "Z" line and a biliary-like esophageal reflux was found in 73.6% and 74.5% of cases, respectively. A significant increase in the incidence and in the severity of erosive esophagitis (EE) was evidenced, whereas nondysplastic Barrett's esophagus (BE) was newly diagnosed in 19 patients (17.2%). No significant correlations were found between GERD symptoms and endoscopic findings.
In the present series the incidence of EE and of BE in SG patients was considerably higher than that reported in the current literature, and it was not related to GERD symptoms. Endoscopic surveillance after SG should be advocated irrespective of the presence of GERD symptoms.
病态肥胖患者比瘦患者更易患胃食管反流病（GERD）和食管裂孔疝（HH）。由于结果相互矛盾，GERD患者行袖状胃切除术（SG）的适应证仍存在争议。
根据临床、内镜和组织学数据评估接受SG患者的GERD发病率。
意大利罗马的大学医院。
2007年7月至2010年1月，162例患者接受了初次SG。术前所有患者均接受GERD症状的视觉模拟量表（VAS）评估、质子泵抑制剂（PPI）使用记录及食管胃十二指肠镜检查（EGD）。胃切除从距幽门6 cm处开始，使用48Fr探条。吻合线用连续缝合加强。建议所有患者术后进行VAS评估、PPI使用情况及EGD的临床检查。3例患者因发生严重术后并发症被排除。
共有110例患者同意参与研究（随访率：69.1%）。平均随访58个月时，GERD症状的发生率、VAS平均评分及PPI摄入量与术前值相比显著增加（68.1%对33.6%：P<0.0001；3对1.8：P = 0.018；57.2%对19.1%：P<0.0001）。EGD检查时，分别有73.6%和74.5%的病例发现“Z”线向上移位及胆汁样食管反流。糜烂性食管炎（EE）的发生率和严重程度显著增加，而19例患者（17.2%）新诊断为非发育异常的巴雷特食管（BE）。GERD症状与内镜检查结果之间未发现显著相关性。
在本系列研究中，SG患者的EE和BE发生率明显高于当前文献报道，且与GERD症状无关。无论是否存在GERD症状，均应提倡SG术后进行内镜监测。
