Impact of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Esophageal Physiology and Gastroesophageal Reflux Disease: A Prospective Study.

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most commonly performed bariatric surgical procedures. The effectiveness of these operations on weight control is well established; however, their impact on esophageal physiology is still under evaluation. The aim of this study is to evaluate the consequences of LSG and LRYGB on esophageal physiology, especially concerning reflux.

METHODS

This prospective study involved 30 patients with severe obesity; 15 underwent LSG, and 15 had LRYGB. Conducted between 2021 and 2023 in Turin, Italy, the study employed preoperative and 1-year postoperative assessments of esophageal function using conventional esophageal manometry, 24-h multichannel intraluminal impedance-pH (MII-pH), upper gastrointestinal series, upper endoscopy, and a validated questionnaire to assess outcomes related to esophageal and lower esophageal sphincter (LES) functions and reflux.

RESULTS

Both groups experienced significant reductions in weight and body mass index, with p-values < 0.001 for both measures. The LRYGB group achieved a significantly higher percentage of excess weight loss compared to the LSG group, with a p-value of < 0.001. In the LSG group, GERD symptoms remained unchanged postoperatively (p = 0.687), with 26.7% using proton pump inhibitors (PPIs) before and after surgery, while in the LRYGB group, GERD symptoms and PPIs use significantly decreased from 53.3 to 6.7% (p = 0.016). Quality of life improved significantly in both groups, with a p-value of 0.001. In the LRYGB group only, esophagitis significantly decreased from 53.3 to 6.7% (p = 0.007), and barium studies showed a significant reduction in reflux signs from 66.7% preoperatively to none postoperatively (p = 0.002). Multichannel intraluminal impedance-pH monitoring revealed significant reductions in reflux metrics for LRYGB group only: total refluxes decreased from 29.0 to 15.0, acidic refluxes from 12.0 to 8.0, and the DeMeester score from 4.70 to 3.70 (p = 0.026, 0.033, and 0.029, respectively). Regarding the manometric parameters, significant changes were observed in the LSG group: total LES length decreased from 34.0 to 31.33 mm (p = 0.027) and residual pressure increased from 2.0 to 4.0 mmHg (p = 0.012), also peristaltic wave amplitude decreased from 98.20 to 52.93 mmHg (p < 0.001), while in the LRYGB group, only the LES residual pressure significantly increased from 2.0 to 4.0 mmHg (p = 0.006).

CONCLUSIONS

LSG and LRYGB are effective for weight loss and improving quality of life. Sleeve gastrectomy controls reflux, with new cases being rare. Advanced diagnostics are key when standard tests are insufficient.