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Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?
World J Gastroenterol. 2017 Apr 07; 23(13):2269-2275.WJ

Abstract

Laparoscopic sleeve gastrectomy (LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease (GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h pH monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve (both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Roux-en-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX® Reflux Management System procedure and the Stretta® procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of pH monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5th International Consensus Conference on sleeve gastrectomy.

Authors+Show Affiliations

Fabrizio Rebecchi, Marco E Allaix, Mario Morino, Department of Surgical Sciences, University of Torino, 10126 Torino, Italy.Fabrizio Rebecchi, Marco E Allaix, Mario Morino, Department of Surgical Sciences, University of Torino, 10126 Torino, Italy.Fabrizio Rebecchi, Marco E Allaix, Mario Morino, Department of Surgical Sciences, University of Torino, 10126 Torino, Italy.Fabrizio Rebecchi, Marco E Allaix, Mario Morino, Department of Surgical Sciences, University of Torino, 10126 Torino, Italy.Fabrizio Rebecchi, Marco E Allaix, Mario Morino, Department of Surgical Sciences, University of Torino, 10126 Torino, Italy.

Pub Type(s)

Editorial

Language

eng

PubMed ID

28428706

Citation

Rebecchi, Fabrizio, et al. "Gastroesophageal Reflux Disease and Morbid Obesity: to Sleeve or Not to Sleeve?" World Journal of Gastroenterology, vol. 23, no. 13, 2017, pp. 2269-2275.
Rebecchi F, Allaix ME, Patti MG, et al. Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve? World J Gastroenterol. 2017;23(13):2269-2275.
Rebecchi, F., Allaix, M. E., Patti, M. G., Schlottmann, F., & Morino, M. (2017). Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve? World Journal of Gastroenterology, 23(13), 2269-2275. https://doi.org/10.3748/wjg.v23.i13.2269
Rebecchi F, et al. Gastroesophageal Reflux Disease and Morbid Obesity: to Sleeve or Not to Sleeve. World J Gastroenterol. 2017 Apr 7;23(13):2269-2275. PubMed PMID: 28428706.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve? AU - Rebecchi,Fabrizio, AU - Allaix,Marco E, AU - Patti,Marco G, AU - Schlottmann,Francisco, AU - Morino,Mario, PY - 2016/11/25/received PY - 2017/01/15/revised PY - 2017/03/15/accepted PY - 2017/4/22/entrez PY - 2017/4/22/pubmed PY - 2018/1/3/medline KW - Ambulatory pH monitoring KW - Esophageal manometry KW - Gastroesophageal reflux KW - Morbid obesity KW - Sleeve gastrectomy SP - 2269 EP - 2275 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 23 IS - 13 N2 - Laparoscopic sleeve gastrectomy (LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease (GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h pH monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve (both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Roux-en-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX® Reflux Management System procedure and the Stretta® procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of pH monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5th International Consensus Conference on sleeve gastrectomy. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/28428706/Gastroesophageal_reflux_disease_and_morbid_obesity:_To_sleeve_or_not_to_sleeve L2 - http://www.wjgnet.com/1007-9327/full/v23/i13/2269.htm DB - PRIME DP - Unbound Medicine ER -