Center of Esophago-gastric and Obesity Surgery (E.G.O.), XI Division and Bariatric Surgery, University Vanvitelli, Naples, Italy.
Obes Surg. 2020 May;30(5):1642-1652. doi: 10.1007/s11695-020-04427-1.
A worrying increase of gastroesophageal reflux disease (GERD) and Barrett esophagus has been reported after sleeve gastrectomy (SG). Recent reports on combined fundoplication and SG seem to accomplish initial favorable results. However, no study included manometry or pH monitoring to evaluate the impact of fundoplication in SG on esophageal physiology.
In this study, 32 consecutive bariatric patients with GERD and/or esophagitis had high-resolution impedance manometry (HRiM) and combined 24-h pH and multichannel intraluminal impedance (MII-pH) before and after laparoscopic sleeve gastrectomy associated to anterior fundoplication (D-SLEEVE). The following parameters were calculated at HRiM: lower esophageal sphincter pressure and relaxation, peristalsis, and mean total bolus transit time. The acid and non-acid GER episodes were assessed by MII-pH, symptom index association (SI), and symptom-association probability (SAP) were also analyzed.
At a median follow-up of 14 months, HRiM showed an increased LES function, and MII-pH showed an excellent control of both acid exposure of the esophagus and number of reflux events. Bariatric outcomes (BMI and EWL%) were also comparable to regular SG (p = NS).
D-SLEEVE is an effective restrictive procedure, which recreates a functional LES pressure able to control and/or prevent mild GERD at 1-year follow-up.
袖状胃切除术（SG）后胃食管反流病（GERD）和 Barrett 食管的发生率令人担忧。最近关于联合胃底折叠术和 SG 的报告似乎取得了初步的良好效果。然而，没有研究包括测压或 pH 监测来评估胃底折叠术在 SG 中对食管生理的影响。
本研究中，32 例 GERD 和/或食管炎的肥胖症患者在接受腹腔镜袖状胃切除术联合前胃底折叠术（D-SLEEVE）前后进行高分辨率阻抗测压（HRiM）和联合 24 小时 pH 和多通道腔内阻抗（MII-pH）检查。在 HRiM 中计算以下参数：食管下括约肌压力和松弛、蠕动和平均总食团通过时间。通过 MII-pH 评估酸和非酸 GER 发作，还分析了症状指数关联（SI）和症状关联概率（SAP）。
在中位随访 14 个月时，HRiM 显示 LES 功能增强，MII-pH 显示酸暴露和反流事件的数量得到了极好的控制。减肥手术结果（BMI 和 EWL%）与常规 SG 相当（p=NS）。
D-SLEEVE 是一种有效的限制手术，可在 1 年随访时重建功能性 LES 压力，以控制和/或预防轻度 GERD。
