title: 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.
  
  
  OBJECTIVE
  To evaluate the incidence of GERD on the basis of clinical, endoscopic, and histologic data in patients undergoing SG.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Genco
authors.affiliation: Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy. Electronic address: emanuele.soricelli@gmail.com.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Soricelli
authors.affiliation: Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casella
authors.affiliation: Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Maselli
authors.affiliation: Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: Lidia
authors.initials: L
authors.lastname: Castagneto-Gissey
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Lorenzo
authors.affiliation: Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Basso
mesh_terms: D000328:Adult; D001471:Barrett Esophagus / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D001706:Biopsy; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors
keywords: Barrett’s esophagus; Gastroesophageal reflux disease; Sleeve gastrectomy