Rhys Kavanagh, Dana Jones, DNP, Emily Avgenakis, PA, M. Umair Bashir, MD, Jessica Smith, MD, FACS, Peter Nau, MD, MS, FACS. The University of Iowa Hospitals and Clinics
Introduction: The Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (LSG) are effective treatments of medically refractory obesity. The RYGB is the gold standard procedure for GERD in an obese population. Performing a LSG in the setting of preexisting reflux may exacerbate symptoms and is an increasingly common indication for a conversion to a RYGB. Preoperative evaluation of the upper GI tract prior to bariatric surgery is variable. This protocol was developed to evaluate patients with GERD and tailor the operation to each patient’s GI function and anatomy.
Methods: A retrospective review of a prospectively collected database was performed on patients that underwent a RYGB or LSG between July 2016 and July 2018. Patients with subjective symptoms of GERD underwent a defined protocol for the pre-operative work-up of the foregut anatomy and function (Figure 1). Studies included endoscopies, pH testing, esophagrams and high resolution esophageal motility (HREM) tests. Data collected included results of objective testing, type of procedure completed and whether the operative choice was influenced by preoperative testing.
Results: 106 patients met inclusion criteria. 33.3% (n=35) underwent an EGD; 66.7% (n=71) completed an esophagram; and 15% (n=16) underwent pH testing/HREM. At EGD a hiatal hernia was identified in 38.24%, Barrett’s in 2.94%, gastritis in 14.7% and esophagitis 17.6% of patients. Esophagram identified a hiatal hernia in 41.27%, dysmotility in 12.7% and reflux in 38.1% of patients. 37.5% of patients had abnormal DeMeester scores and 43.7% of patients had esophageal dysmotility. Prior to testing 41.5% of patients were deemed better candidates for a LRYGB, 27.37% as better candidates for LSG and 31.13% as a candidate for either operation. Following testing, the operation performed was changed or selected based on preoperative testing in 26.42% of patients resulting in 62.26% of patients undergoing LRYGB and 37.74% undergoing LSG.
Conclusion: Upper GI pathology is common and varied in the bariatric population. A large number of patients with endorsed symptoms of reflux have pathology that, if diagnosed, will guide optimal bariatric procedure selection. Incorporation of this protocol involving selective foregut evaluation aids in surgical discission making and will improve outcomes and patient satisfaction..jpg)
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93988
Program Number: S136
Presentation Session: Bariatric V – GERD and Esophageal Physiology
Presentation Type: Podium