Bariatric and Metabolic Surgery Unit, Clínica Obésitas, Hospital Vithas 9 de Octubre, Valencia, Spain.
Bariatric and Metabolic Surgery Unit, General and Digestive Surgery Service, Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Negrín, Gran Canarias, Spain.
Surg Obes Relat Dis. 2022 Apr;18(4):546-554. doi: 10.1016/j.soard.2021.11.011. Epub 2021 Nov 13.
Major concerns years after the sleeve gastrectomy (SG) include weight regain, development of hiatal hernia (HH) and gastroesophageal reflux disease, with esophagitis and Barrett's esophagus (BE). Both problems could be related, and the incidence of asymptomatic patients is troubling.
To study the incidence of reflux symptoms, esophagitis, BE, HH, and asymptomatic pathology and their relationship with weight regain in patients 5 years after undergoing SG at different bariatric centers in Spain.
Public and private hospitals with bariatric surgery units.
Prospective, multicenter, nonrandomized study involving 13 Spanish hospitals with a cumulative experience of 4,500 patients having undergone the SG procedure and patients who had been subjected to the procedure at least 5 years previously along with preoperative gastroscopy. The clinical history, preoperative gastroscopy, and technical details of the SG were recorded. A specific clinical questionnaire was given that recorded the intake volume, perception of satiety, and gastroesophageal reflux (GER) symptoms. Gastroscopy, pH-metry, and manometry studies were carried out, and the data were analyzed statistically. The study has been authorized by the official Spanish ethics committee CEI/CEIm Hospital Universitario Gran Canaria Dr Negrín (code 2019-216-1).
One hundred and five patients who underwent SG and who had with at least 5 years of follow-up were included. All procedures were performed laparoscopically. The mean age of patients was 51.1 years, and 70.5% were women. The mean characteristics of the SG procedure were a 37.2F probe, at 4.6 cm from the pylorus, and a crura closure was performed in 5 cases. There were no major complications (Clavien-Dindo grade >3) or deaths. The average preoperative body mass index was 46.3 kg/m, the minimum reached was 20.6 kg/m, whereas the average after 5 years was of 34.5 kg/m. GER, HH, and esophagitis symptoms went from 17.1%, 28.6%, and 5.7%, respectively, before the SG to 76%, 30.5%, and 31.4%, respectively, 5 years after the procedure. Symptoms persisted over the years in 37.1% of cases and presented de novo in 52.8% of cases. Fifty-three percent of manometries (n = 27, total 51) and 64% of pH-metries (n = 32, total 53; DeMeester average score was 65) were pathologic 5 years after the procedure. Concerning gastroscopies, 5 years after the procedure, HH was found in 33 patients (30.5% of total) and esophagitis in 32 patients (31.4% of total). Eighty patients (76%) had GER symptoms, and 25 patients (24%) were asymptomatic. Only 1 patient (.9%) developed BE.
Our study has confirmed a high rate of both persistent and de novo esophagitis and hiatal hernia, many of which were asymptomatic, 5 years after SG had been performed. Weight regain and a striking increase in gastric capacity are risk factors indicative of esophagitis, even when patients are asymptomatic. We consider a control gastroscopy and the preventive use of proton pump inhibitors necessary in these cases regardless of symptoms. We recommend that a control gastroscopy should be performed in all cases regardless of symptoms 5 years after SG. Further studies are needed to validate these recommendations.
袖状胃切除术（SG）多年后主要关注的问题包括体重反弹、食管裂孔疝（HH）和胃食管反流病，以及食管炎和 Barrett 食管（BE）。这两个问题可能有关联，无症状患者的发病率令人担忧。
研究西班牙不同减重中心 5 年后接受 SG 治疗的患者中出现反流症状、食管炎、BE、HH 和无症状病理学及其与体重反弹的关系。
具有减重手术单位的公立医院和私立医院。
前瞻性、多中心、非随机研究，涉及 13 家西班牙医院，累计有 4500 例患者接受了 SG 手术，且这些患者在术前至少 5 年接受了该手术，同时还进行了术前胃镜检查。记录了临床病史、术前胃镜检查和 SG 的技术细节。给予了特定的临床问卷，记录了摄入量、饱腹感感知和胃食管反流（GER）症状。进行了胃镜检查、pH 监测和测压研究，并进行了统计学分析。该研究已获得西班牙官方伦理委员会的授权（CEI/CEIm Hospital Universitario Gran Canaria Dr Negrín，编号 2019-216-1）。
纳入了 105 例接受 SG 且随访时间至少 5 年的患者。所有手术均经腹腔镜进行。患者的平均年龄为 51.1 岁，70.5%为女性。SG 手术的平均特征为 37.2F 探头，距幽门 4.6cm，5 例患者行膈脚闭合。无重大并发症（Clavien-Dindo 分级>3）或死亡。术前平均体重指数为 46.3kg/m，最低值为 20.6kg/m，而 5 年后平均为 34.5kg/m。SG 前 GER、HH 和食管炎症状分别为 17.1%、28.6%和 5.7%，5 年后分别为 76%、30.5%和 31.4%。症状在数年内持续存在的比例为 37.1%，新出现的比例为 52.8%。53%的测压（n=27，总数 51）和 64%的 pH 监测（n=32，总数 53；DeMeester 平均评分 65）在术后 5 年时呈病理性。关于胃镜检查，SG 术后 5 年时发现 33 例患者（总病例数的 30.5%）存在 HH，32 例患者（总病例数的 31.4%）存在食管炎。80 例（76%）患者有 GER 症状，25 例（24%）患者无症状。仅有 1 例（0.9%）患者发生 BE。
我们的研究证实，SG 术后 5 年，食管炎和食管裂孔疝的持续存在和新发比例均较高，其中许多为无症状。体重反弹和胃容量明显增加是食管炎的危险因素，即使患者无症状。我们认为，无论症状如何，这些情况下均需要进行预防性质子泵抑制剂治疗。我们建议无论症状如何，SG 后 5 年应进行控制胃镜检查。需要进一步的研究来验证这些建议。
