Maria Veronica Gorodner, MD1, Agustin Matucci, MD1, Laura Sole, MD2, Ricardo Figueredo, MD2, Christian Sanchez, MD2, Luis Caro, MD2, Alejandro Grigaites, MD1. 1Programa Unidades Bariatricas, 2Gastroenterologia Diagnóstica y Terapéutica
Introduction: Laparoscopic Roux -en- Y gastric bypass (LRYGB) has been proposed as the treatment of choice for obesity combined with gastroesophageal reflux disease (GERD). However, there are few reports showing objective data based on esophageal function tests (EFT’s) to prove its benefit. The aim of our study was to evaluate the true influence of LRYGB on GERD.
Methods and Procedures: Candidates for laparoscopic sleeve gastrectomy (LSG) underwent preoperative esophageal manometry (EM) and 24-hs pH monitoring. Based on the negative influence of LSG on GERD, patients with abnormal pH monitoring were offered a LRYGB. Those patients repeated EFT’s starting one year after surgery. Esophagogastroduodenoscopy (EGD) was also performed preoperatively and one year after the operation. Symptoms were evaluated using a validated score. EFT’s, EGD results and symptoms were compared before and after surgery.
Results: Between 4/12 and 8/18, 250 LSG candidates underwent preoperative EFT’s; 95 of them were re-directed to LRYGB due to abnormal pH monitoring. From 74 patients who were one year out of surgery, 13 (18%) completed their EFT’s postoperatively. There were 10 women, age 40±7 years, BMI 41±1 kg/m². At 36 months, % excess weight loss (EWL) was 75±22. EM: lower esophageal sphincter (LES) length increased from 2.6 to 2.9 cm (p= NS), and LES pressure slightly decreased from 15 to 14.2 mmHg (p= NS). Preoperatively, LES was normotensive in 12 (92%) patients; postoperatively, LES was normal in 11 (85%) (p= NS). DeMeester score decreased from 35.7 to 11 (p= < 0.001). Postoperatively, 9 (69%) patients resolved their GERD, 3 (23%) improved their GERD status, and 1 (8%) remained the same (p< 0.001). No difference was seen between preop. and postop. symptoms’ score. Two patients (15%) had grade A esophagitis preoperatively. One of them was able to resolved it while the other one remained the same.
Conclusion: Our preliminary data showed that after LRYGB, LESP remained almost the same, the DeMeester score significantly decreased, while 69% of patients objectively resolved their GERD. LRYGB seems to be an excellent treatment option for obesity combined with GERD.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94255
Program Number: S139
Presentation Session: Bariatric V – GERD and Esophageal Physiology
Presentation Type: Podium
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