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Does sleeve gastrectomy expose the distal esophagus to severe reflux?: A systematic review and meta-analysis

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Title: Does sleeve gastrectomy expose the distal esophagus to severe reflux?: A systematic review and meta-analysis
Authors: Yeung, KTD
Penney, N
Ashrafian, L
Darzi, A
Ashrafian, H
Item Type: Journal Article
Abstract: MINI: The reported prevalence of new-onset or worsening gastroesophageal reflux disease after sleeve gastrectomy is controversial. Subsequent esophagitis and Barrett's esophagus can be serious unintended sequalae. The aim of this study was to systematically appraise all existing published data to assess the effect of sleeve gastrectomy on gastroesophageal reflux, esophagitis, and Barrett's esophagus. OBJECTIVE: The aim of this study was to appraise the prevalence of gastroesophageal reflux disease (GERD), esophagitis, and Barrett's esophagus (BE) after sleeve gastrectomy (SG) through a systematic review and meta-analysis. BACKGROUND: The precise prevalence of new-onset or worsening GERD after SG is controversial. Subsequent esophagitis and BE can be a serious unintended sequalae. Their postoperative prevalence remains unclear. METHODS: A systematic literature search was performed to identify studies evaluating postoperative outcomes in primary SG for morbid obesity. The primary outcome was prevalence of GERD, esophagitis, and BE after SG. Meta-analysis was performed to calculate combined prevalence. RESULTS: A total of 46 studies totaling 10,718 patients were included. Meta-analysis found that the increase of postoperative GERD after sleeve (POGAS) was 19% and de novo reflux was 23%. The long-term prevalence of esophagitis was 28% and BE was 8%. Four percent of all patients required conversion to RYGB for severe reflux. CONCLUSIONS: The postoperative prevalence of GERD, esophagitis, and BE following SG is significant. Symptoms do not always correlate with the presence of pathology. As the surgical uptake of SG continues to increase, there is a need to ensure that surgical decision-making and the consent process for this procedure consider these long-term complications while also ensuring their postoperative surveillance through endoscopic and physiological approaches. The long-term outcomes of this commonly performed bariatric procedure should be considered alongside its weight loss and metabolic effects.
Issue Date: 20-Mar-2019
Date of Acceptance: 1-Mar-2019
URI: http://hdl.handle.net/10044/1/68203
DOI: https://dx.doi.org/10.1097/SLA.0000000000003275
ISSN: 0003-4932
Publisher: Lippincott, Williams & Wilkins
Journal / Book Title: Annals of Surgery
Copyright Statement: © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: RDB04
Keywords: Surgery
11 Medical and Health Sciences
Publication Status: Published online
Conference Place: USA
Embargo Date: 2020-03-20
Online Publication Date: 2019-03-20
Appears in Collections:Division of Surgery
Faculty of Medicine



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