Castagneto-Gissey Lidia, Genco Alfredo, Del Corpo Giulia, Badiali Danilo, Pronio Anna Maria, Casella Giovanni
Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
Surg Obes Relat Dis. 2020 Nov;16(11):1629-1637. doi: 10.1016/j.soard.2020.07.013. Epub 2020 Jul 19.
The impact of sleeve gastrectomy (SG) on gastroesophageal reflux disease (GERD) is still greatly debated. Most of the current evidence available is solely based on symptom evaluation or medication use, while a minority have implemented objective functional measurements.
To better comprehend the pathophysiological mechanisms involved in the genesis of GERD after SG.
University Hospital, Italy.
A total of 21 patients affected by morbid obesity and eligible for SG were prospectively enrolled in the present study. Patients were evaluated by means of endoscopy, high-resolution manometry (HRM), 24-hour pH monitoring, and the Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaire.
Follow-up was completed at least 1 year post operation (mean follow-up, 14.3 ± 2.1 mo) by 19 patients. Body mass index decreased from 41.2 ± .9 to 26.8 ± .8 kg/m (P < .001). Distal contractile integral significantly decreased from 2772.8 ± 399.9 mm Hg/s/cm to 2060.4 ± 338.9 mm Hg/s/cm (P = .01). The 24-hour pH monitoring showed an overall reduction tendency of acid reflux, although this was not statistically significant. All analyzed endoscopic findings withstood substantial pejorative modifications after SG (P < .01). Distal contractile integral values at baseline predicted postoperative Z-line upward migration; HRM, distal latency, and DeMeester score at baseline predicted the development of erosive esophagitis at follow-up, by bootstrap estimates of a logistic regression.
Postoperative GERD-related esophageal sequelae should be carefully considered after SG. Our results demonstrate how acid reflux does not seem to play a relevant role in the pathophysiology of post-SG GERD. Baseline HRM can help stratify the risk of developing erosive esophagitis and Z-line upward migration after SG, while postoperative endoscopic surveillance should be encouraged regardless of the presence or absence of symptoms.
袖状胃切除术（SG）对胃食管反流病（GERD）的影响仍存在很大争议。目前大多数现有证据仅基于症状评估或药物使用情况，而少数研究采用了客观的功能测量方法。
更好地理解SG术后GERD发生的病理生理机制。
意大利大学医院。
本研究前瞻性纳入了21例病态肥胖且适合SG的患者。通过内镜检查、高分辨率测压（HRM）、24小时pH监测以及胃食管反流病健康相关生活质量问卷对患者进行评估。
19例患者在术后至少1年完成随访（平均随访时间为14.3±2.1个月）。体重指数从41.2±0.9降至26.8±0.8kg/m²（P<0.001）。远端收缩积分从2772.8±399.9mmHg/s/cm显著降至2060.4±338.9mmHg/s/cm（P = 0.01）。24小时pH监测显示酸反流总体呈下降趋势，尽管无统计学意义。所有分析的内镜检查结果在SG术后均出现明显恶化（P<0.01）。基线时的远端收缩积分值可预测术后Z线向上移位；通过逻辑回归的自抽样估计，基线时的HRM、远端潜伏期和DeMeester评分可预测随访时糜烂性食管炎的发生。
SG术后应仔细考虑与GERD相关的食管后遗症。我们的结果表明，酸反流似乎在SG术后GERD的病理生理过程中不起重要作用。基线HRM有助于对SG术后发生糜烂性食管炎和Z线向上移位的风险进行分层，无论有无症状，均应鼓励术后进行内镜监测。
