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The Causes of Gastroesophageal Reflux after Laparoscopic Sleeve Gastrectomy: Quantitative Assessment of the Structure and Function of the Esophagogastric Junction by Magnetic Resonance Imaging and High-Resolution Manometry.
Obes Surg. 2020 Jun; 30(6):2108-2117.OS

Abstract

BACKGROUND

The incidence of de novo gastroesophageal reflux disease (GERD) after LSG is substantial. However, an objective correlation with the structural gastric and EGJ changes has not been demonstrated yet. We aimed to prospectively evaluate the effects of laparoscopic sleeve gastrectomy (LSG) on the structure and function of the esophagogastric junction (EGJ) and stomach.

METHODS

Investigations were performed before and after > 50% reduction in excess body weight (6-12 months after LSG). Subjects with GERD at baseline were excluded. Magnetic Resonance Imaging (MRI), high-resolution manometry (HRM), and ambulatory pH-impedance measurements were used to assess the structure and function of the EGJ and stomach before and after LSG.

RESULTS

From 35 patients screened, 23 (66%) completed the study (age 36 ± 10 years, BMI 42 ± 5 kg/m2). Mean excess weight loss was 59 ± 18% after 7.1 ± 1.7-month follow-up. Esophageal acid exposure (2.4 (1.5-3.2) to 5.1 (2.8-7.3); p = 0.040 (normal < 4.0%)) and reflux events increased after surgery (57 ± 24 to 84 ± 38; p = 0.006 (normal < 80/day)). Esophageal motility was not altered by surgery; however, intrabdominal EGJ length and pressure were reduced (both p < 0.001); whereas the esophagogastric insertion angle (35° ± 11° to 51° ± 16°; p = 0.0004 (normal < 60°)) and esophageal opening diameter (16.9 ± 2.8 mm to 18.0 ± 3.7 mm; p = 0.029) were increased. The increase in reflux events correlated with changes in EGJ insertion angle (p = 0.010). Patients with > 80% reduction in gastric capacity (TGV) had the highest prevalence of symptomatic GERD.

CONCLUSION

LSG has multiple effects on the EGJ and stomach that facilitate reflux. In particular, EGJ disruption as indicated by increased (more obtuse) esophagogastric insertion angle and small gastric capacity were associated with the risk of GERD after LSG. clinicaltrials.gov: NCT01980420.

Authors+Show Affiliations

IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France. Digestive Surgery, Fondazione Policlinico Universitario "A. Gemelli" IRCSS, Rome, Italy.IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France. claudio.fiorillo@hotmail.it. Digestive Surgery, Fondazione Policlinico Universitario "A. Gemelli" IRCSS, Rome, Italy. claudio.fiorillo@hotmail.it.IRCAD, Research Institute against Digestive Cancer, Strasbourg, France.IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France. Digestive Surgery, Fondazione Policlinico Universitario "A. Gemelli" IRCSS, Rome, Italy.Department of Gastroenterology and Hepatology, University Hospital Zürich, CH-8091, Zürich, Switzerland.Department of Gastroenterology and Hepatology, University Hospital Zürich, CH-8091, Zürich, Switzerland. Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Digestive Diseases, Center for Integrative Gastroenterology, Klinik Arlesheim, CH-4144, Arlesheim, Switzerland.IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France. IRCAD, Research Institute against Digestive Cancer, Strasbourg, France. Department of Digestive and Endocrine Surgery, NHC, Strasbourg, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32207049

Citation

Quero, Giuseppe, et al. "The Causes of Gastroesophageal Reflux After Laparoscopic Sleeve Gastrectomy: Quantitative Assessment of the Structure and Function of the Esophagogastric Junction By Magnetic Resonance Imaging and High-Resolution Manometry." Obesity Surgery, vol. 30, no. 6, 2020, pp. 2108-2117.
Quero G, Fiorillo C, Dallemagne B, et al. The Causes of Gastroesophageal Reflux after Laparoscopic Sleeve Gastrectomy: Quantitative Assessment of the Structure and Function of the Esophagogastric Junction by Magnetic Resonance Imaging and High-Resolution Manometry. Obes Surg. 2020;30(6):2108-2117.
Quero, G., Fiorillo, C., Dallemagne, B., Mascagni, P., Curcic, J., Fox, M., & Perretta, S. (2020). The Causes of Gastroesophageal Reflux after Laparoscopic Sleeve Gastrectomy: Quantitative Assessment of the Structure and Function of the Esophagogastric Junction by Magnetic Resonance Imaging and High-Resolution Manometry. Obesity Surgery, 30(6), 2108-2117. https://doi.org/10.1007/s11695-020-04438-y
Quero G, et al. The Causes of Gastroesophageal Reflux After Laparoscopic Sleeve Gastrectomy: Quantitative Assessment of the Structure and Function of the Esophagogastric Junction By Magnetic Resonance Imaging and High-Resolution Manometry. Obes Surg. 2020;30(6):2108-2117. PubMed PMID: 32207049.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Causes of Gastroesophageal Reflux after Laparoscopic Sleeve Gastrectomy: Quantitative Assessment of the Structure and Function of the Esophagogastric Junction by Magnetic Resonance Imaging and High-Resolution Manometry. AU - Quero,Giuseppe, AU - Fiorillo,Claudio, AU - Dallemagne,Bernard, AU - Mascagni,Pietro, AU - Curcic,Jelena, AU - Fox,Mark, AU - Perretta,Silvana, PY - 2020/3/25/pubmed PY - 2020/3/25/medline PY - 2020/3/25/entrez KW - GERD KW - Laparoscopic Sleeve Gastrectomy KW - Magnetic Resonance Imaging (MRI) SP - 2108 EP - 2117 JF - Obesity surgery JO - Obes Surg VL - 30 IS - 6 N2 - BACKGROUND: The incidence of de novo gastroesophageal reflux disease (GERD) after LSG is substantial. However, an objective correlation with the structural gastric and EGJ changes has not been demonstrated yet. We aimed to prospectively evaluate the effects of laparoscopic sleeve gastrectomy (LSG) on the structure and function of the esophagogastric junction (EGJ) and stomach. METHODS: Investigations were performed before and after > 50% reduction in excess body weight (6-12 months after LSG). Subjects with GERD at baseline were excluded. Magnetic Resonance Imaging (MRI), high-resolution manometry (HRM), and ambulatory pH-impedance measurements were used to assess the structure and function of the EGJ and stomach before and after LSG. RESULTS: From 35 patients screened, 23 (66%) completed the study (age 36 ± 10 years, BMI 42 ± 5 kg/m2). Mean excess weight loss was 59 ± 18% after 7.1 ± 1.7-month follow-up. Esophageal acid exposure (2.4 (1.5-3.2) to 5.1 (2.8-7.3); p = 0.040 (normal < 4.0%)) and reflux events increased after surgery (57 ± 24 to 84 ± 38; p = 0.006 (normal < 80/day)). Esophageal motility was not altered by surgery; however, intrabdominal EGJ length and pressure were reduced (both p < 0.001); whereas the esophagogastric insertion angle (35° ± 11° to 51° ± 16°; p = 0.0004 (normal < 60°)) and esophageal opening diameter (16.9 ± 2.8 mm to 18.0 ± 3.7 mm; p = 0.029) were increased. The increase in reflux events correlated with changes in EGJ insertion angle (p = 0.010). Patients with > 80% reduction in gastric capacity (TGV) had the highest prevalence of symptomatic GERD. CONCLUSION: LSG has multiple effects on the EGJ and stomach that facilitate reflux. In particular, EGJ disruption as indicated by increased (more obtuse) esophagogastric insertion angle and small gastric capacity were associated with the risk of GERD after LSG. clinicaltrials.gov: NCT01980420. SN - 1708-0428 UR - https://www.unboundmedicine.com/medline/citation/32207049/The_Causes_of_Gastroesophageal_Reflux_after_Laparoscopic_Sleeve_Gastrectomy:_Quantitative_Assessment_of_the_Structure_and_Function_of_the_Esophagogastric_Junction_by_Magnetic_Resonance_Imaging_and_High_Resolution_Manometry_ L2 - https://dx.doi.org/10.1007/s11695-020-04438-y DB - PRIME DP - Unbound Medicine ER -
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