Lee Young Min, Barazanchi Ahmed, Robertson Jason, Murphy Rinki, Booth Michael W C
Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand.
Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
ANZ J Surg. 2025 May;95(5):911-918. doi: 10.1111/ans.19369. Epub 2025 Jan 19.
Laparoscopic sleeve gastrectomy (LSG) is a potentially refluxogenic operation while Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is regarded as an anti-reflux procedure. The aim of this study is to compare long-term incidence of Barrett's Oesophagus (BO) and gastroesophageal reflux disease (GORD) following LSG and LRYGB.
Participants of a double-blinded randomized controlled trial comparing banded LRYGB and LSG for remission of type 2 diabetes were contacted to take part. A gastroscopy was performed. Primary outcome was endoscopic and histologic evidence of BO. Secondary outcomes included reflux and regurgitation scores, presence of oesophagitis, proton-pump inhibitor (PPI) usage, Body Mass Index (BMI), and percentage excess weight loss (%EWL).
Forty-eight of 109 patients were enrolled into the study (LSG 26 vs. LRYGB 22). Mean follow-up was 7.5 years for the LSG group, and 7.4 years for the RYGB group (P = 0.22). 8 LSG patients had BO while 3 LRYGB patients had BO (30.8%vs13.6%, P = 0.19). There was no significant difference in the mean reflux (8.1 ± 9.4(0-36) vs. 9.3 ± 8.8(0-34), P = 0.47) and regurgitation scores (7.7 ± 6.9(0-22) vs. 11.5 ± 10.5(0-44), P = 0.23) for LSG versus LRYGB patients or between those with and without BO. PPI usage before and after surgery was 6/26 (23.1%) versus 13/26 (50.0%) and 8/22 (36.4%) versus 12/22 (54.5%) for LSG and LRYGB patients respectively. PPI usage in patients with and without BO was 7/11 versus 18/37. EWL was significantly greater (P = 0.0013) in the LRYGB group (74.8 ± 28.1%) compared to LSG group (49.7 ± 18.7%).
Long-term incidence of BO trended towards but was not significantly higher for LSG compared to LRYGB group. We support routine endoscopic surveillance for bariatric patients.
腹腔镜袖状胃切除术（LSG）是一种潜在的致反流手术，而腹腔镜Roux-en-Y胃旁路术（LRYGB）被认为是一种抗反流手术。本研究的目的是比较LSG和LRYGB术后巴雷特食管（BO）和胃食管反流病（GORD）的长期发病率。
联系了一项比较带环LRYGB和LSG治疗2型糖尿病缓解情况的双盲随机对照试验的参与者以参与研究。进行了胃镜检查。主要结局是BO的内镜和组织学证据。次要结局包括反流和反刍评分、食管炎的存在、质子泵抑制剂（PPI）的使用、体重指数（BMI）和超重减轻百分比（%EWL）。
109例患者中有48例纳入研究（LSG组26例，LRYGB组22例）。LSG组平均随访7.5年，RYGB组平均随访7.4年（P = 0.22）。8例LSG患者有BO，3例LRYGB患者有BO（30.8%对13.6%，P = 0.19）。LSG组与LRYGB组患者之间，以及有和没有BO的患者之间，平均反流评分（8.1±9.4(0 - 36)对9.3±8.8(0 - 34)，P = 0.47）和反刍评分（7.7±6.9(0 - 22)对11.5±10.5(0 - 44)，P = 0.23）无显著差异。LSG组和LRYGB组患者术前和术后PPI的使用率分别为6/26（23.1%）对13/26（50.0%）和8/22（36.4%）对12/22（54.5%）。有和没有BO的患者中PPI的使用率分别为7/11和18/37。与LSG组（49.7±18.7%）相比，LRYGB组的EWL显著更高（P = 0.0013）（74.8±28.1%）。
与LRYGB组相比，LSG组BO的长期发病率有升高趋势，但无显著差异。我们支持对肥胖症患者进行常规内镜监测。
