Evaluation of gastroesophageal reflux before and after sleeve gastrectomy using symptom scoring, scintigraphy, and endoscopy.
BACKGROUND
The effect of laparoscopic sleeve gastrectomy (SG) on gastroesophageal reflux disease (GERD) has been a controversial issue. There have been limited studies on this aspect and most of the published studies are retrospective. Therefore, a prospective study was designed to objectively assess the problem. The objective of this study was to assess the impact of SG on symptoms of gastroesophageal reflux using questionnaire, endoscopy, and radionuclide scintigraphy.


METHODS
Thirty-two patients undergoing laparoscopic sleeve gastrectomy were assessed for gastroesophageal reflux using Carlsson Dent Questionnaire and GERD questionnaire before and after surgery at three monthly intervals. They were also subjected to upper GI endoscopy (UGIE) and radionuclide scintigraphy both pre- and postoperatively.


RESULTS
Mean preoperative weight and body mass index were 126.5 kg and 47.8 kg/m2, respectively. Mean percent excess weight loss at 12 months was 64.3 ± 18.4. Both the Carlsson Dent Score (CDS) and Severity Score (SS) exhibited a decline from 2.88 to 1.63 (p<0.05) and 2.28 to 1.06 (p<0.05), respectively after 12 months. Radionuclide scintigraphy revealed a significant rise of GERD from 6.25% to 78.1% in the postoperative period (p<0.001). UGIE showed a rise in incidence of esophagitis from 18.8% to 25%; however, there was improvement in all patients except one in terms of reduction of severity of esophagitis.


CONCLUSIONS
Presence of GERD may not be considered as a contra-indication for sleeve gastrectomy. There is improvement of GERD as assessed by symptom questionnaires, as well as improvement in grade of esophagitis. The new onset GERD detected on scintigraphy may not be pathologic as there is a decrease in total acid production postsurgery; however, it still remains an important issue and needs long-term follow-up.
Departments of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
Aditya
A
Sharma
Departments of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India. Electronic address: sandeep_aiims@yahoo.co.in.
Sandeep
S
Aggarwal
Gastroenterology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
Vineet
V
Ahuja
Nuclear Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
Chandrashekhar
C
Bal
D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D011795:Surveys and Questionnaires; D015431:Weight Loss; D055815:Young Adult
Endoscopy; Gastroesophageal reflux; Scintigraphy; Sleeve gastrectomy