Time-dependent burden of reflux-related endoscopic pathology after sleeve gastrectomy: Clinical value of surveillance endoscopy in a 520-patient cohort

doi:10.4240/wjgs.124213

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Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Nov 27, 2026; 18(11): 124213
Published online Nov 27, 2026. doi: 10.4240/wjgs.124213

Time-dependent burden of reflux-related endoscopic pathology after sleeve gastrectomy: Clinical value of surveillance endoscopy in a 520-patient cohort

Sinan Aslan, Hacı Vural Soyer, Mehmet Hatip Adiguzel, Samed Sayar

Sinan Aslan, Hacı Vural Soyer, Mehmet Hatip Adiguzel, Samed Sayar, Department of General Surgery, Mersin City Training and Research Hospital, Mersin 33240, Türkiye

Co-first authors: Sinan Aslan and Hacı Vural Soyer.

Author contributions: Aslan S and Soyer HV designed the study; Sayar S and Adiguzel MH were responsible for developing the methodology; Soyer HV, Aslan S and Sayar S participated in the formal analysis and investigation; Soyer HV wrote the original draft; Aslan S, Soyer HV, Adiguzel MH and Sayar S participated in the review and editing. Aslan S and Soyer HV contributed equally to this work as co-first authors.

AI contribution statement: AI tools, including Paperpal AI-assisted workflows, were used only to assist with English language editing and proofreading support. No AI tool was listed as an author or co-author. All analyses, interpretations, references, and manuscript content were critically reviewed, verified, and approved by the authors. The authors take full responsibility for the integrity, accuracy, originality, and validity of the manuscript.

Institutional review board statement: This study was approved by the Ethics Committee of Mersin City Training and Research Hospital, No. 2026/251.

Informed consent statement: Due to the retrospective nature of the study and the use of anonymized patient data, the requirement for written informed consent was waived by the Ethics Committee of Mersin City Training and Research Hospital.

Conflict-of-interest statement: The authors declare that they have no conflicts of interest.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The datasets generated and analyzed during the current study are not publicly available due to institutional privacy regulations but are available from the corresponding author upon reasonable request and with appropriate institutional permission.

Corresponding author: Hacı Vural Soyer, MD, Department of General Surgery, Mersin City Training and Research Hospital, Toroslar, Mersin 33240, Türkiye. hvuralsoyer@yahoo.com

Received: June 10, 2026
Revised: July 12, 2026
Accepted: July 27, 2026
Published online: November 27, 2026
Processing time: 155 Days and 14 Hours

Abstract

BACKGROUND

Sleeve gastrectomy is a widely performed procedure; however, postoperative gastroesophageal reflux disease (GERD) and reflux-related mucosal injury remain clinically persistent concerns. The value and timing of postoperative surveillance endoscopy are controversial, particularly because symptoms may not fully reflect mucosal pathology.

AIM

To evaluate time-dependent, reflux-related, clinical and endoscopic pathology after sleeve gastrectomy and to assess the clinical utility of postoperative surveillance endoscopy.

METHODS

This retrospective cohort study included adults who underwent sleeve gastrectomy and both pre- and postoperative upper gastrointestinal endoscopy. Among 560 patients screened, 520 were included in the final cohort; after excluding those with preoperative Barrett’s, 502 were eligible for de novo Barrett’s esophagus analysis. The primary endpoint was strict clinically significant postoperative endoscopic pathology, defined as Los Angeles grade B (LA-B) or higher erosive esophagitis, histology-confirmed Barrett’s, de novo Barrett’s, or esophageal stricture. A broader clinically actionable endpoint was analyzed separately.

RESULTS

The mean follow-up was 52.8 ± 20.9 months. GERD symptoms increased from 26.5% to 43.3%, proton pump inhibitor use increased from 22.5% to 50.6%, erosive esophagitis increased from 16.0% to 29.6%, LA-B or higher esophagitis increased from 5.8% to 13.1%, and Barrett’s increased from 3.5% to 10.0%. De novo Barrett’s esophagus occurred in 34/502 (6.8%) patients. Strict clinically significant pathology was present in 108/520 (20.8%) patients, and broader clinically actionable pathology was present in 198/520 (38.1%). Treatment changes occurred in 172/520 (33.1%) patients.

CONCLUSION

Reflux-related clinical/endoscopic findings increase after sleeve gastrectomy, especially at longer follow-up intervals, thus supporting risk-adapted endoscopic surveillance, particularly beyond 3-5 years, but do not establish requirements for annual endoscopy.

Keywords: Sleeve gastrectomy; Gastroesophageal reflux disease; Erosive esophagitis; Barrett’s esophagus; Surveillance endoscopy; Bariatric surgery

Core Tip: Sleeve gastrectomy was associated with increased reflux-related clinical and endoscopic findings in this 520-patient cohort with paired pre- and postoperative endoscopy data. De novo Barrett’s esophagus was detected in 34/502 (6.8%) eligible patients. Strict clinically significant postoperative endoscopic pathology was greater at longer follow-up intervals, reaching 53/175 (30.3%) beyond 60 months, whereas treatment change reached 90/175 (51.4%) within the same interval. These findings support structured, risk-adapted endoscopic surveillance, particularly beyond 3-5 years, but do not establish the need for universal annual endoscopy.