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

Table 1 Baseline demographic and clinical characteristics

Characteristic	Overall (n = 520), n/N (%)
Age, years	45.9 ± 10.6
Preoperative BMI, kg/m²	43.8 ± 4.5
Follow-up duration, months	52.8 ± 20.9
Female sex	332/520 (63.8)
Smoking status	114/520 (21.9)
Diabetes mellitus	145/520 (27.9)
Hypertension	184/520 (35.4)
Obstructive sleep apnea	105/520 (20.2)
Preoperative GERD symptoms	138/520 (26.5)
Preoperative PPI use	117/520 (22.5)
Preoperative bile reflux	29/520 (5.6)
Preoperative hiatal hernia	110/520 (21.2)
Preoperative erosive esophagitis	83/520 (16.0)
Preoperative LA-B-or-higher esophagitis	30/520 (5.8)
Preoperative Barrett’s esophagus	18/520 (3.5)
Follow-up group: 24-36 months	144/520 (27.7)
Follow-up group: 36-60 months	201/520 (38.7)
Follow-up group: > 60 months	175/520 (33.7)
Postoperative GERD symptoms	225/520 (43.3)
Postoperative PPI use	263/520 (50.6)
Postoperative bile reflux	74/520 (14.2)
Postoperative hiatal hernia	100/520 (19.2)
Postoperative erosive esophagitis	154/520 (29.6)
Postoperative LA-B-or-higher esophagitis	68/520 (13.1)
Postoperative Barrett’s esophagus	52/520 (10.0)
Histology-confirmed Barrett’s esophagus	52/520 (10.0)
Esophageal stricture	14/520 (2.7)
Treatment change after postoperative endoscopy	172/520 (33.1)
De novo Barrett’s esophagus	34/502 (6.8)

BMI: Body mass index; GERD: Gastroesophageal reflux disease; PPI: Proton pump inhibitor; LA-B: Los Angeles grade B.

Table 2 Preoperative vs postoperative reflux-related findings

Finding	Preoperative, n/N (%)	Postoperative, n/N (%)	Absolute change, percentage points	McNemar P value
GERD symptoms	138/520 (26.5)	225/520 (43.3)	16.7	< 0.001
PPI use	117/520 (22.5)	263/520 (50.6)	28.1	< 0.001
Bile reflux	29/520 (5.6)	74/520 (14.2)	8.7	< 0.001
Hiatal hernia	110/520 (21.2)	100/520 (19.2)	-1.9	0.407
Erosive esophagitis	83/520 (16.0)	154/520 (29.6)	13.7	< 0.001
LA-B-or-higher esophagitis	30/520 (5.8)	68/520 (13.1)	7.3	< 0.001
Barrett’s esophagus	18/520 (3.5)	52/520 (10.0)	6.5	< 0.001

GERD: Gastroesophageal reflux disease; PPI: Proton pump inhibitor; LA-B: Los Angeles grade B.

Table 3 Time-dependent postoperative outcomes

Outcome	24-36 months, n/N (%)	36-60 months, n/N (%)	> 60 months, n/N (%)	Overall P value	Trend P value
Postoperative GERD symptoms	60/144 (41.7)	88/201 (43.8)	77/175 (44.0)	0.900	0.684
Postoperative PPI use	60/144 (41.7)	97/201 (48.3)	106/175 (60.6)	0.002	< 0.001
Postoperative bile reflux	21/144 (14.6)	25/201 (12.4)	28/175 (16.0)	0.609	0.677
Postoperative hiatal hernia	13/144 (9.0)	37/201 (18.4)	50/175 (28.6)	< 0.001	< 0.001
Postoperative erosive esophagitis	35/144 (24.3)	57/201 (28.4)	62/175 (35.4)	0.085	0.028
Postoperative LA-B+ esophagitis	11/144 (7.6)	21/201 (10.4)	36/175 (20.6)	0.001	< 0.001
Postoperative Barrett’s esophagus	9/144 (6.2)	20/201 (10.0)	23/175 (13.1)	0.124	0.041
De novo Barrett’s esophagus	3/138 (2.2)	14/195 (7.2)	17/169 (10.1)	0.023	0.007
Esophageal stricture	1/144 (0.7)	4/201 (2.0)	9/175 (5.1)	0.037	0.013
Strict clinically significant postoperative endoscopic pathology	18/144 (12.5)	37/201 (18.4)	53/175 (30.3)	< 0.001	< 0.001
Broader clinically actionable postoperative pathology	29/144 (20.1)	67/201 (33.3)	102/175 (58.3)	< 0.001	< 0.001
Treatment change after postoperative endoscopy	25/144 (17.4)	57/201 (28.4)	90/175 (51.4)	< 0.001	< 0.001

GERD: Gastroesophageal reflux disease; PPI: Proton pump inhibitor; LA-B: Los Angeles grade B.

Table 4 Multivariable predictors of strict clinically significant postoperative endoscopic pathology

Variable	OR	95%CI	P value
Age, per year	1.03	1.01-1.06	0.007
Female sex vs male	0.62	0.38-1.00	0.051
Preoperative BMI, per kg/m²	0.98	0.93-1.04	0.496
Smoking status: Yes vs no	3.10	1.81-5.31	< 0.001
Preoperative GERD symptoms: Yes vs no	5.17	3.17-8.44	< 0.001
Preoperative LA-B-or-higher esophagitis: Yes vs no	1.68	0.67-4.21	0.272
Follow-up 36-60 months vs 24-36 months	1.94	1.00-3.77	0.050
Follow-up > 60 months vs 24-36 months	4.65	2.40-9.03	< 0.001

BMI: Body mass index; GERD: Gastroesophageal reflux disease; LA-B: Los Angeles grade B; OR: Odds ratio; CI: Confidence interval.

Table 5 Multivariable predictors of de novo Barrett’s esophagus

Variable	OR	95%CI	P value
Age, per year	1.04	1.01-1.08	0.021
Female sex vs male	0.33	0.16-0.71	0.004
Smoking status: Yes vs no	2.88	1.32-6.26	0.008
Preoperative GERD symptoms: Yes vs no	2.41	1.14-5.09	0.021
Follow-up 36-60 months vs 24-36 months	4.13	1.14-15.02	0.031
Follow-up > 60 months vs 24-36 months	6.73	1.86-24.36	0.004

GERD: Gastroesophageal reflux disease; OR: Odds ratio; CI: Confidence interval.