Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication
Abstract Background Morbidly obese patients are affected by gastroesophageal reflux disease (GERD) and hiatal hernia (HH) more frequently than lean patients. Because of conflicting results, the indication to sleeve gastrectomy (SG) in patients with GERD is still debated. Objectives To evaluate the i...
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| creator | Genco, Alfredo, M.D Soricelli, Emanuele, M.D Casella, Giovanni, M.D., Ph.D Maselli, Roberta, M.D Castagneto-Gissey, Lidia, M.D Di Lorenzo, Nicola, M.D Basso, Nicola, M.D |
| description | Abstract Background Morbidly obese patients are affected by gastroesophageal reflux disease (GERD) and hiatal hernia (HH) more frequently than lean patients. Because of conflicting results, the indication to sleeve gastrectomy (SG) in patients with GERD is still debated. Objectives To evaluate the incidence of GERD on the basis of clinical, endoscopic, and histologic data in patients undergoing SG. Settings University hospital, Rome, Italy. Methods From July 2007 to January 2010, 162 patients underwent primary SG. Preoperatively all patients underwent visual analogue scale (VAS) evaluation of GERD symptoms, proton pump inhibitors (PPIs) consumption recording, and esophagogastroduodenoscopy (EGD). Stomach resection started 6 cm from pylorus on a 48Fr bougie. Staple line was reinforced by an oversewing suture. A postoperative clinical control with VAS evaluation, PPI consumption, and EGD was proposed to all patients. Three patients were excluded because of the occurrence of major postoperative complications. Results A total of 110 patients accepted to take part in the study (follow-up rate: 69.1%). At a mean 58 months of follow-up, incidence of GERD symptoms, VAS mean score, and PPI intake significantly increased compared with preoperative values (68.1% versus 33.6%: P |
| doi_str_mv | 10.1016/j.soard.2016.11.029 |
| format | Article |
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Because of conflicting results, the indication to sleeve gastrectomy (SG) in patients with GERD is still debated. Objectives To evaluate the incidence of GERD on the basis of clinical, endoscopic, and histologic data in patients undergoing SG. Settings University hospital, Rome, Italy. Methods From July 2007 to January 2010, 162 patients underwent primary SG. Preoperatively all patients underwent visual analogue scale (VAS) evaluation of GERD symptoms, proton pump inhibitors (PPIs) consumption recording, and esophagogastroduodenoscopy (EGD). Stomach resection started 6 cm from pylorus on a 48Fr bougie. Staple line was reinforced by an oversewing suture. A postoperative clinical control with VAS evaluation, PPI consumption, and EGD was proposed to all patients. Three patients were excluded because of the occurrence of major postoperative complications. Results A total of 110 patients accepted to take part in the study (follow-up rate: 69.1%). At a mean 58 months of follow-up, incidence of GERD symptoms, VAS mean score, and PPI intake significantly increased compared with preoperative values (68.1% versus 33.6%: P <.0001; 3 versus 1.8: P = .018; 57.2% versus 19.1%: P <.0001) At EGD, an upward migration of the “Z” line and a biliary-like esophageal reflux was found in 73.6% and 74.5% of cases, respectively. A significant increase in the incidence and in the severity of erosive esophagitis (EE) was evidenced, whereas nondysplastic Barrett’s esophagus (BE) was newly diagnosed in 19 patients (17.2%). No significant correlations were found between GERD symptoms and endoscopic findings. Conclusion In the present series the incidence of EE and of BE in SG patients was considerably higher than that reported in the current literature, and it was not related to GERD symptoms. Endoscopic surveillance after SG should be advocated irrespective of the presence of GERD symptoms.</description><identifier>ISSN: 1550-7289</identifier><identifier>EISSN: 1878-7533</identifier><identifier>DOI: 10.1016/j.soard.2016.11.029</identifier><identifier>PMID: 28089434</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Barrett Esophagus - diagnosis ; Barrett Esophagus - epidemiology ; Barrett Esophagus - etiology ; Barrett’s esophagus ; Biopsy ; Endoscopy, Digestive System - methods ; Female ; Follow-Up Studies ; Gastrectomy - adverse effects ; Gastroenterology and Hepatology ; Gastroesophageal Reflux - diagnosis ; Gastroesophageal Reflux - epidemiology ; Gastroesophageal Reflux - etiology ; Gastroesophageal reflux disease ; Humans ; Incidence ; Italy - epidemiology ; Laparoscopy - adverse effects ; Male ; Middle Aged ; Obesity, Morbid - surgery ; Postoperative Complications ; Retrospective Studies ; Sleeve gastrectomy ; Surgery ; Time Factors</subject><ispartof>Surgery for obesity and related diseases, 2017-04, Vol.13 (4), p.568-574</ispartof><rights>American Society for Bariatric Surgery</rights><rights>2017 American Society for Bariatric Surgery</rights><rights>Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-5f67a572e8d0c0946c1b41f42e1783f805b2de1faa100cb762a1c6058ca2f7a73</citedby><cites>FETCH-LOGICAL-c459t-5f67a572e8d0c0946c1b41f42e1783f805b2de1faa100cb762a1c6058ca2f7a73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.soard.2016.11.029$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28089434$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Genco, Alfredo, M.D</creatorcontrib><creatorcontrib>Soricelli, Emanuele, M.D</creatorcontrib><creatorcontrib>Casella, Giovanni, M.D., Ph.D</creatorcontrib><creatorcontrib>Maselli, Roberta, M.D</creatorcontrib><creatorcontrib>Castagneto-Gissey, Lidia, M.D</creatorcontrib><creatorcontrib>Di Lorenzo, Nicola, M.D</creatorcontrib><creatorcontrib>Basso, Nicola, M.D</creatorcontrib><title>Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication</title><title>Surgery for obesity and related diseases</title><addtitle>Surg Obes Relat Dis</addtitle><description>Abstract Background Morbidly obese patients are affected by gastroesophageal reflux disease (GERD) and hiatal hernia (HH) more frequently than lean patients. Because of conflicting results, the indication to sleeve gastrectomy (SG) in patients with GERD is still debated. Objectives To evaluate the incidence of GERD on the basis of clinical, endoscopic, and histologic data in patients undergoing SG. Settings University hospital, Rome, Italy. Methods From July 2007 to January 2010, 162 patients underwent primary SG. Preoperatively all patients underwent visual analogue scale (VAS) evaluation of GERD symptoms, proton pump inhibitors (PPIs) consumption recording, and esophagogastroduodenoscopy (EGD). Stomach resection started 6 cm from pylorus on a 48Fr bougie. Staple line was reinforced by an oversewing suture. A postoperative clinical control with VAS evaluation, PPI consumption, and EGD was proposed to all patients. Three patients were excluded because of the occurrence of major postoperative complications. Results A total of 110 patients accepted to take part in the study (follow-up rate: 69.1%). At a mean 58 months of follow-up, incidence of GERD symptoms, VAS mean score, and PPI intake significantly increased compared with preoperative values (68.1% versus 33.6%: P <.0001; 3 versus 1.8: P = .018; 57.2% versus 19.1%: P <.0001) At EGD, an upward migration of the “Z” line and a biliary-like esophageal reflux was found in 73.6% and 74.5% of cases, respectively. A significant increase in the incidence and in the severity of erosive esophagitis (EE) was evidenced, whereas nondysplastic Barrett’s esophagus (BE) was newly diagnosed in 19 patients (17.2%). No significant correlations were found between GERD symptoms and endoscopic findings. Conclusion In the present series the incidence of EE and of BE in SG patients was considerably higher than that reported in the current literature, and it was not related to GERD symptoms. Endoscopic surveillance after SG should be advocated irrespective of the presence of GERD symptoms.</description><subject>Adult</subject><subject>Barrett Esophagus - diagnosis</subject><subject>Barrett Esophagus - epidemiology</subject><subject>Barrett Esophagus - etiology</subject><subject>Barrett’s esophagus</subject><subject>Biopsy</subject><subject>Endoscopy, Digestive System - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastrectomy - adverse effects</subject><subject>Gastroenterology and Hepatology</subject><subject>Gastroesophageal Reflux - diagnosis</subject><subject>Gastroesophageal Reflux - epidemiology</subject><subject>Gastroesophageal Reflux - etiology</subject><subject>Gastroesophageal reflux disease</subject><subject>Humans</subject><subject>Incidence</subject><subject>Italy - epidemiology</subject><subject>Laparoscopy - adverse effects</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Obesity, Morbid - surgery</subject><subject>Postoperative Complications</subject><subject>Retrospective Studies</subject><subject>Sleeve gastrectomy</subject><subject>Surgery</subject><subject>Time Factors</subject><issn>1550-7289</issn><issn>1878-7533</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUsuO1DAQjBCIXQa-AAn5yIEE23k5SKwEK1iQVuIAnK0euzN4cOLgTlbMjW_gxu_xJTjMwIELJ9tSVbWrqrPsoeCF4KJ5ui8oQLSFTI9CiILL7lZ2LlSr8rYuy9vpXtc8b6XqzrJ7RHvOy6Zu5d3sTCquuqqszrPvV0BzDEhh-gQ7BM8i9n75yqwjBEIGo2UvIUac55_ffhA7IRdi0M8YmYcJYiATJmcYecQbZLtVE80chsMzBmwKRG7r8QlbRosRaXYDzGiZD-MuTyIDM2GYvDMwuzDez-704AkfnM5N9vH1qw-Xb_Lrd1dvL19c56aquzmv-6aFZAeV5YZ3VWPEthJ9JVG0quwVr7fSougBBOdm2zYShGl4rQzIvoW23GSPj7pTDF-W9Cs9ODLoPYwYFtJCNaIWSqXYNll5hJpklVJCeorJQzxowfVaht7r32XotQwthE5lJNaj04BlO6D9y_mTfgI8PwIw2bxxGDUZh6NB69b4tA3uPwMu_uEb78YUo_-MB6R9WOKYEtRCk9Rcv1_3YV0H0ZRcVZ0qfwGszbX6</recordid><startdate>20170401</startdate><enddate>20170401</enddate><creator>Genco, Alfredo, M.D</creator><creator>Soricelli, Emanuele, M.D</creator><creator>Casella, Giovanni, M.D., Ph.D</creator><creator>Maselli, Roberta, M.D</creator><creator>Castagneto-Gissey, Lidia, M.D</creator><creator>Di Lorenzo, Nicola, M.D</creator><creator>Basso, Nicola, M.D</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170401</creationdate><title>Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication</title><author>Genco, Alfredo, M.D ; Soricelli, Emanuele, M.D ; Casella, Giovanni, M.D., Ph.D ; Maselli, Roberta, M.D ; Castagneto-Gissey, Lidia, M.D ; Di Lorenzo, Nicola, M.D ; Basso, Nicola, M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-5f67a572e8d0c0946c1b41f42e1783f805b2de1faa100cb762a1c6058ca2f7a73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Barrett Esophagus - diagnosis</topic><topic>Barrett Esophagus - epidemiology</topic><topic>Barrett Esophagus - etiology</topic><topic>Barrett’s esophagus</topic><topic>Biopsy</topic><topic>Endoscopy, Digestive System - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastrectomy - adverse effects</topic><topic>Gastroenterology and Hepatology</topic><topic>Gastroesophageal Reflux - diagnosis</topic><topic>Gastroesophageal Reflux - epidemiology</topic><topic>Gastroesophageal Reflux - etiology</topic><topic>Gastroesophageal reflux disease</topic><topic>Humans</topic><topic>Incidence</topic><topic>Italy - epidemiology</topic><topic>Laparoscopy - adverse effects</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Obesity, Morbid - surgery</topic><topic>Postoperative Complications</topic><topic>Retrospective Studies</topic><topic>Sleeve gastrectomy</topic><topic>Surgery</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Genco, Alfredo, M.D</creatorcontrib><creatorcontrib>Soricelli, Emanuele, M.D</creatorcontrib><creatorcontrib>Casella, Giovanni, M.D., Ph.D</creatorcontrib><creatorcontrib>Maselli, Roberta, M.D</creatorcontrib><creatorcontrib>Castagneto-Gissey, Lidia, M.D</creatorcontrib><creatorcontrib>Di Lorenzo, Nicola, M.D</creatorcontrib><creatorcontrib>Basso, Nicola, M.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery for obesity and related diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Genco, Alfredo, M.D</au><au>Soricelli, Emanuele, M.D</au><au>Casella, Giovanni, M.D., Ph.D</au><au>Maselli, Roberta, M.D</au><au>Castagneto-Gissey, Lidia, M.D</au><au>Di Lorenzo, Nicola, M.D</au><au>Basso, Nicola, M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication</atitle><jtitle>Surgery for obesity and related diseases</jtitle><addtitle>Surg Obes Relat Dis</addtitle><date>2017-04-01</date><risdate>2017</risdate><volume>13</volume><issue>4</issue><spage>568</spage><epage>574</epage><pages>568-574</pages><issn>1550-7289</issn><eissn>1878-7533</eissn><abstract>Abstract Background Morbidly obese patients are affected by gastroesophageal reflux disease (GERD) and hiatal hernia (HH) more frequently than lean patients. Because of conflicting results, the indication to sleeve gastrectomy (SG) in patients with GERD is still debated. Objectives To evaluate the incidence of GERD on the basis of clinical, endoscopic, and histologic data in patients undergoing SG. Settings University hospital, Rome, Italy. Methods From July 2007 to January 2010, 162 patients underwent primary SG. Preoperatively all patients underwent visual analogue scale (VAS) evaluation of GERD symptoms, proton pump inhibitors (PPIs) consumption recording, and esophagogastroduodenoscopy (EGD). Stomach resection started 6 cm from pylorus on a 48Fr bougie. Staple line was reinforced by an oversewing suture. A postoperative clinical control with VAS evaluation, PPI consumption, and EGD was proposed to all patients. Three patients were excluded because of the occurrence of major postoperative complications. Results A total of 110 patients accepted to take part in the study (follow-up rate: 69.1%). At a mean 58 months of follow-up, incidence of GERD symptoms, VAS mean score, and PPI intake significantly increased compared with preoperative values (68.1% versus 33.6%: P <.0001; 3 versus 1.8: P = .018; 57.2% versus 19.1%: P <.0001) At EGD, an upward migration of the “Z” line and a biliary-like esophageal reflux was found in 73.6% and 74.5% of cases, respectively. A significant increase in the incidence and in the severity of erosive esophagitis (EE) was evidenced, whereas nondysplastic Barrett’s esophagus (BE) was newly diagnosed in 19 patients (17.2%). No significant correlations were found between GERD symptoms and endoscopic findings. Conclusion In the present series the incidence of EE and of BE in SG patients was considerably higher than that reported in the current literature, and it was not related to GERD symptoms. Endoscopic surveillance after SG should be advocated irrespective of the presence of GERD symptoms.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28089434</pmid><doi>10.1016/j.soard.2016.11.029</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Barrett Esophagus - diagnosis Barrett Esophagus - epidemiology Barrett Esophagus - etiology Barrett’s esophagus Biopsy Endoscopy, Digestive System - methods Female Follow-Up Studies Gastrectomy - adverse effects Gastroenterology and Hepatology Gastroesophageal Reflux - diagnosis Gastroesophageal Reflux - epidemiology Gastroesophageal Reflux - etiology Gastroesophageal reflux disease Humans Incidence Italy - epidemiology Laparoscopy - adverse effects Male Middle Aged Obesity, Morbid - surgery Postoperative Complications Retrospective Studies Sleeve gastrectomy Surgery Time Factors |
| title | Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication |
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