Published online Sep 7, 2019. doi: 10.3748/wjg.v25.i33.4805
Peer-review started: February 27, 2019
First decision: April 30, 2019
Revised: August 3, 2019
Accepted: August 19, 2019
Article in press: August 19, 2019
Published online: September 7, 2019
Obesity is a global health epidemic with considerable economic burden. Surgical solutions have become increasingly popular following technical advances leading to sustained efficacy and reduced risk. Sleeve gastrectomy accounts for almost half of all bariatric surgeries worldwide but concerns regarding its relationship with gastroesophageal reflux disease (GERD) has been a topic of debate. GERD, including erosive esophagitis, is highly prevalent in the obese population. The role of pre-operative endoscopy in bariatric surgery has been controversial. Two schools of thought exist on the matter, one that believes routine upper endoscopy before bariatric surgery is not warranted in the absence of symptoms and another that believes that symptoms are poor predictors of underlying esophageal pathology. This debate is particularly important considering the evidence for the association of laparoscopic sleeve gastrectomy (LSG) with de novo and/or worsening GERD compared to the less popular Roux-en-Y gastric bypass procedure. In this paper, we try to address 3 burning questions regarding the inter-relationship of obesity, GERD, and LSG: (1) What is the prevalence of GERD and erosive esophagitis in obese patients considered for bariatric surgery? (2) Is it necessary to perform an upper endoscopy in obese patients considered for bariatric surgery? And (3) What are the long-term effects of sleeve gastrectomy on GERD and should LSG be done in patients with pre-existing GERD?
Core tip: The convenience and ease of sleeve gastrectomy comes at a risk of de novo or worsening of pre-existing gastroesophageal reflux disease. Candidates for bariatric surgery should have a thorough evaluation of reflux symptoms as well as esophageal anatomy and pathology. This should be followed by an informed and open discussion with the patient about risks and benefits of different bariatric surgical options leading to optimal shared decision making.