Gastroesophageal reflux disease (GERD) is a contraindication for sleeve gastrectomy (SG) for 23.3% of experts according to the results of the 5th International Consensus Conference on the current status of SG.
GERD can be the result of SG, caused by the increased intraluminal pressure or twisting. The onset of new symptoms after surgery is detected in 10-23% of patients who undergo a SG, whereas lower rates are found after gastric bypass (GB) or adjustable banding.
These rates vary depending on the definition of GERD that is used for diagnosis. The use of a complete physiopathological evaluation with a validated questionnaire, upper endoscopy, esophageal manometry and 24-hour pH may more accurate, detecting 5.4% of real “de novo” GERD.
Symptoms of GERD seem to improve after GB, even though some studies have reported up to 28% of GERD 10 years after GB. However, rates of reoperation after SG because of GERD are very low. A GB is indicated in these cases, as well as a repair of hiatal herniation.
Barret’s esophagus (BE) is also a concern in these cases. Its progression factors are age over 70, male gender, no proton-pump inhibitor (PPI) treatment, candidiasis, and no anti-reflux surgery. Systematic endoscopies and biopsies are indicated. Treatment of BE includes techniques such as radiofrequency or electrical stimulation of the lower esophageal sphincter. Nevertheless, esophagogastric cancer after bariatric surgery is very rare.
Finally, Dr. Noel talks about the gastric clip or reversible laparoscopic SG, which might be an option in the future.
