Review
Copyright ©The Author(s) 2015.
World J Gastroenterol. Sep 28, 2015; 21(36): 10348-10357
Published online Sep 28, 2015. doi: 10.3748/wjg.v21.i36.10348
Table 1 Symptoms of gastroesophageal reflux disease
GERD in obesityDe novo GERD after SGImprovement of GERD after SG
MechanismIncreasing BMILack of gastric complianceReduced intra-abdominal pressure
Increasing intragastric pressureIncreased intraluminal pressureReduced acid production
Increasing gastroesophageal pressure gradientGastric fundus removalAccelerated gastric emptying
Hiatal herniaLES pressureReduced gastric volume
Final shape of the sleeve
Narrowing at the junction of the vertical and horizontal parts of the sleeve
Twisting of the sleeve
Dilation of the fundus
Persistence of hiatal hernia
GERD: Gastroesophageal reflux disease; SG: Sleeve gastrectomy.
Table 2 Negative impact of sleeve gastrectomy on gastroesophageal reflux disease
Ref.Nature of the studyPatients, nPre-operative BMI (kg/m2)GERD evaluationFollow-up (mo)GERD (%) PreopGERD (%) Postop
Himpens et al[21], 2006Prospective randomized: GB vs LSG4039Clinical evaluation36-De Novo
At 1 yr: 21.8%
At 3 yr: 3.1%
Arias et al[23], 2009Retrospective review13043.2NA360De novo: 2.1%
Braghetto et al[25], 2010Retrospective review, and literature review16737 ± 4.4Clinical score: EGD, EM--Increase
Braghetto et al[26], 2010Retrospective review2038.3Clinical score: EM--Increase
Lakdawala et al[27], 2010Retrospective review50--12-Increase
Himpens et al[22], 2010Retrospective review3039.9NA723.30%23%
Carter et al[28], 2011Retrospective review17646.6Clinical evaluation2434.60%47.2%
33.8% (of total) under medication
Howard et al[29], 2011Retrospective review2855.5Clinical evaluation UGICS87 (25%)11 (39%)
De novo: 18%
Soricelli et al[24], 2013Retrospective review: SG + HHR37844 ± 3.5Clinical score: EGD, UGICS, EM. 24-h pH1860/378 (15.8%)71/ 378 (18.7%)
SG: 19/281 (6.7%)SG: 68 (24%)
SG+HHR: 41/97 (42%)SG+HHR: 3/97 (3.1%)
Sieber et al[30], 2014Retrospective review6843 ± 8Clinical evaluation: EGD, UGICS, EM6050%Persistance : 44.1%
De novo: 16%
Gorodner et al[31], 2014Retrospective review. Influence of LSG on GERD1440 ± 6Demeester score: BM, EGD, EM. 24-h pH144 (29%)9 (64%)
Burgerhart et al[32], 2014Prospective study2047.6 ± 6.1RDQ; EM. 24-h pH314 (70%)Persistance: 8 (57%)
Acid exposure: 4.1 %No change: 2 (14%)
Worsening: 6 (43%)
De novo: 10%
Acid exposure: 12%
Dupree et al[33], 2014Retrospective review483247 ± 9Clinical evaluation3644.50%Persistence: 84.1%
De novo: 8.6%
Total: 13 studies
LSG: Laparoscopic sleeve gastrectomy; GERD: Gastroesophageal reflux disease; BM: Barium meal; EGD: Esophogastroduodenoscopy; EM: Esophageal manometry; HHR: Hiatal hernia repair; UGICS: Upper gastrointestinal contrast study; NA: Not available; GB: Gastric banding; RDQ: Reflux-disease questionnaire.
Table 3 Positive impact of a sleeve gastrectomy on gastroesophageal reflux disease
Ref.Nature of the studyPatients, nPre-operative BMI (kg/m2)GERD evaluationFollow-up (mo)GERD (%) PreopGERD (%) Postop
Melissas et al[39], 2008Prospective study1449.5CA242 (14%)1 (7%)
Nocca et al[40], 2008Multicenter prospective study16345.9NA2410 (6.1%)6 (3.6%)
Petersen et al[41], 2012Prospective study: 3 groups3750.5 and 47.5CA; EMNANALESP: 8.4 to 21.2 mmHg may protect against GERD
Chopra et al[42], 2012Retrospective review and analysis18549.0CA; EGD6NAImprovement: 46%
De novo: 3.2%
Daes et al[35], 2012Concurrent cohort study13439.0CA; EGD1249.2%1.50%
Rawlins et al[43], 2013Retrospective study5565.0CA; NA6027%27%
53% resolution
16% de novo
Santonicola et al[37], 2013Retrospective comparative180LSG: 36.5CA13-18LSG: 39.2 %LSG: 22.5%, de novo: 17.7%
LSG vs LSG + HHR78 LSGLSG + HHR: 39.3EGDLSG + HHR: 38.4%LSG+HHR: 43.3%, de novo: 22.9%
102 LSG + HHRIf GERD: dc - BM
Sharma et al[19], 2014Prospective study3247.8CDS12CDS: 2.88CDS: 1.63 (P < 0.05)
GERD SSSS: 2.28SS: 1.06 (P < 0.05)
EGDRS: 6.25%RS: 78.1%(P < 0.001)
RSEsophagitis: 18.8%Esophagitis: 25%, reduction of severity
Rebecchi et al[20], 2014Prospective study7144.3GSAS24A:A:
A: PAEEGDGSAS: 53.1GSAS: 13.1
B: NAEBMDemeester: 39.5Demeester: 10.6
EMB:B:
24-h pHDemeester: 11.9Demeester: 12
de novo: 5.4%
Pallati et al[38], 2014Prospective database58548.5GERD-symptom grading based on medication use6All patients includedScore improvement 41%
Worsening: 4.6 %
de novo: 9.2%
Del genio et al[44], 2014Prospective database2546.1CA; HRiM, MII-pH13Patient excluded if preop. GERDNo de novo GERD
Retrospective analysis
Daes et al[36], 2014Prospective evaluation38237.7CA2244.5%2.6%
EGD94% resolution of symptoms
Total: 12 studies
NA: Not available; CA: Clinical assessment; UGICS: Upper gastrointestinal contrast series; LSG: Laparoscopic sleeve gastrectomy; HHR: Hiatal hernia repair; EGD: Esophogastroduodenoscopy; GERD: Gastroesophageal reflux disease; dc-BM: Double contrast after a barium meal; CDQ: Carlsson Dent Score; GERD SS: GERD Symptom Score; RS: Radionuclide scintigraphy; GSAS: Gastroesophageal Reflux Disease Symptom Assessment Scale; EM: Esophageal manometry; PAE: Pathologic acid exposure; NAE: Normal acid exposure; HRiM: High-resolution impedance manometry; MII-pH: Combined 24-H pH-multichannel intraluminal impedance; LESP: Lower esophageal sphincter pressure.
Table 4 Laparoscopic sleeve gastrectomy and hiatal hernia repair
No change in GERDImprovement of GERD
Santonicola et al[37], 2014Cuenca-abente et al (case report, no MeSH) 2006
Parikh et al (case report, no MeSH) 2008
Korwar V et al (case report, biological MeSH) 2009
Valera et al (case report, MeSH) 2009
Merchant et al (case report, biologic MeSH) 2009
Soricelli et al[24,50] 2010 (mesh in 2 patients) and 2013 (no MeSH)
Soliman[58] (no mesh, except 2 patients with large HH) 2012
Kotak et al (case report, no MeSH) 2013
Gibson et al[59] (no mesh) 2013 Daes et al[35,36] (no MeSH) 2012 and 2013
GERD: Gastroesophageal reflux disease.