Division of General Surgery, Medicine Hat Regional Hospital, 116 Carry Dr, Suite 114, Medicine Hat, Alberta, T1B 3Z8, Canada.
Faculty of Medicine, University of Calgary, Calgary, Canada.
Obes Surg. 2021 Dec;31(12):5148-5155. doi: 10.1007/s11695-021-05688-0. Epub 2021 Oct 2.
Sleeve gastrectomy (SG) has become the most popular bariatric procedure worldwide. However, SG is associated with de novo gastroesophageal reflux (GERD) and esophagitis, with concerns for progression into Barrett's esophagus (BE). The purpose of this study is to assess the clinical and endoscopic progression of GERD, esophagitis, and BE 3 to 4 years after SG.
Fifty-eight patients (pts) were assessed with endoscopy preoperative and at 3 to 4 years post SG, representing 44.9% follow-up. Endoscopy was offered to all SG pts regardless of symptoms. Outcomes including percent total weight loss (%TWL), PPI use, esophagitis progression, de novo reflux, and BE formation.
At post-op follow-up, the %TWL was 23%. The average BMI dropped from 49.07 to 37.5. De novo reflux developed in 13 pts (30.9%). Of the 16 pts with GERD pre-op, 37.5% improved, 25% had stable disease, and 37.5% had worsening symptoms. The rate of esophagitis nearly doubled from 37.9% pre-op to 70.6% post-op. A majority of post-op pts had mild esophagitis (87.8%), with 12.1% with LA classes C and D. Asymptomatic esophagitis was found in 68.2% of post-op pts. The incidence of BE was 12.7% post-op, with de novo BE developing in 4 pts, representing 7.2%.
SG is associated with increased rates of asymptomatic esophagitis and de novo reflux at 3 to 4 years post-op. De novo BE was detected as well, highlighting the importance of post-op screening. The majority of pts with GERD pre-op have stable disease or improve.
袖状胃切除术（SG）已成为全球最流行的减重手术。然而，SG 与新发胃食管反流（GERD）和食管炎相关，并担心进展为巴雷特食管（BE）。本研究的目的是评估 SG 后 3 至 4 年内 GERD、食管炎和 BE 的临床和内镜进展。
58 例患者（pts）在术前和 SG 后 3 至 4 年内接受了内镜评估，占随访的 44.9%。无论症状如何，所有 SG 患者均接受内镜检查。结果包括总体重减轻百分比（%TWL）、PPI 使用、食管炎进展、新发反流和 BE 形成。
术后随访时，%TWL 为 23%。平均 BMI 从 49.07 降至 37.5。13 例患者（30.9%）出现新发反流。术前有 GERD 的 16 例患者中，37.5%的患者症状改善，25%的患者病情稳定，37.5%的患者症状恶化。食管炎的发生率从术前的 37.9%几乎翻了一番，达到术后的 70.6%。大多数术后患者的食管炎较轻（87.8%），其中 12.1%为 LA 分级 C 和 D。术后无症状性食管炎的发生率为 68.2%。术后 BE 的发生率为 12.7%，4 例患者新发 BE，占 7.2%。
SG 后 3 至 4 年内，无症状性食管炎和新发反流的发生率增加。还发现了新发 BE，这突出了术后筛查的重要性。术前有 GERD 的大多数患者病情稳定或改善。
