Clinique de Chirurgie Cancérologique Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalo-universitaire de Nantes (CHU) Hôtel-Dieu, Nantes, France.
L'institut du thorax, Department of Endocrinology, CHU Nantes, Nantes, France; L'institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France.
Surg Obes Relat Dis. 2020 Sep;16(9):1219-1224. doi: 10.1016/j.soard.2020.04.010. Epub 2020 Apr 19.
Obesity is well known to increase the risk of gastroesophageal reflux disease (GERD). The impact of sleeve gastrectomy (SG) on GERD is still discussed but seems to be associated with the development of de novo GERD or the exacerbation of preexisting GERD.
The objective of this study was to evaluate the impact of preoperative pH monitoring, using the DeMeester score (DMS), on the risk of conversion to Roux-en-Y gastric bypass (RYGB) after SG.
University Hospital in Nantes, France.
This monocentric study reported the results of a retrospective chart review of 523 obese individuals treated between 2011 and 2018. All patients underwent primary bariatric surgery; 95% had undergone an SG. GERD diagnosis was established with preoperative DMS based on 24-hour esophageal pH monitoring.
Preoperative DMS was identified in 423 patients (86%). Sixty-seven patients (14%) underwent a second bariatric procedure; among them, 36 (54%) have been converted to RYGB because of GERD. There was no significant difference between preoperative DMS (16.1 ± 22 versus 13.7 ± 14, P = .37) in patients undergoing conversion for GERD and the nonconverted ones. The sensitivity, specificity, positive predictive, and negative predictive values of the preoperative DMS for predicting conversion to RYGB were 25%, 66%, 7%, and 4%, respectively. In patients who underwent a conversion for GERD, DMS (P < .002), rates of esophagitis (P = .035), and hiatal hernia (P = .039) significantly increased after SG.
Preoperative DMS alone is not predictive of the risk of conversion of SG to RYGB for GERD.
肥胖众所周知会增加胃食管反流病（GERD）的风险。袖状胃切除术（SG）对 GERD 的影响仍存在争议，但似乎与新发生的 GERD 或原有 GERD 的恶化有关。
本研究旨在评估术前 pH 监测（使用 DeMeester 评分[DMS]）对 SG 后转为 Roux-en-Y 胃旁路术（RYGB）的风险的影响。
法国南特大学医院。
这项单中心研究报告了 2011 年至 2018 年间治疗的 523 名肥胖患者的回顾性图表分析结果。所有患者均接受了原发性减重手术；95%的患者接受了 SG。GERD 诊断基于 24 小时食管 pH 监测的术前 DMS。
423 例患者（86%）有术前 DMS。67 例患者（14%）接受了第二次减重手术；其中 36 例（54%）因 GERD 转为 RYGB。GERD 转为 RYGB 的患者与未转为 RYGB 的患者之间，术前 DMS（16.1 ± 22 与 13.7 ± 14，P =.37）无显著差异。术前 DMS 预测转为 RYGB 的灵敏度、特异度、阳性预测值和阴性预测值分别为 25%、66%、7%和 4%。在因 GERD 转为 RYGB 的患者中，SG 后 DMS（P <.002）、食管炎发生率（P =.035）和食管裂孔疝（P =.039）显著增加。
单独的术前 DMS 不能预测 SG 转为 RYGB 治疗 GERD 的风险。
