May Pouch Volume and Shape Influence GERD Symptoms Resolution After Conversional Roux-en-Y Gastric Bypass for Sleeve Gas
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LETTER TO THE EDITOR
May Pouch Volume and Shape Influence GERD Symptoms Resolution After Conversional Roux-en-Y Gastric Bypass for Sleeve Gastrectomy Related Erosive Esophagitis? Antonio Iannelli 1,2,3
&
Luigi Schiavo 4
Received: 4 September 2020 / Revised: 19 September 2020 / Accepted: 28 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Dear Editor, We read with particular interest the paper by Lim et al. reporting the results of the conversion of sleeve gastrectomy (SG) to Roux-en-Y (RYGB) for erosive esophagitis published in Obesity Surgery [1]. The authors reported a selected cohort of 14 patients presenting with endoscopic proven erosive esophagitis undergoing conversion to RYGB. Interestingly these patients represented only 2% of the whole series including more than 700 cases done over a 10-year period at a single institution. These data are of great interest and indicate that a second surgery for symptomatic erosive esophagitis resistant to PPI is required in a very limited subset of patients. To this respect, it should be stressed that esophagitis and Barrett’s esophagus may remain clinically silent [2]. Indeed, in France, the French and Francophone Society for Obesity Surgery (SOFFCO—Societé Française et Francophone Chirurgie de l’Obésité) currently recommends a systematic endoscopy at 5 years after the SG. The authors found a complete resolution of symptoms in 7 patients (50%) while in 6 only partial resolution and in one patient no change in GERD symptoms was recorded. * Antonio Iannelli [email protected] Luigi Schiavo [email protected] 1
University Côte d’Azur, Nice, France
2
Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Archet 2 Hospital, Nice, France
3
Inserm, U1065, Team 8 “Hepatic Complications of Obesity and Alcohol”, Nice, France
4
Department of Medicine, Surgery, and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Fisciano, Italy
The authors have to be commended for their research that includes a baseline questionnaire to objectively measure GERD symptoms which are rarely reported in published studies on the topic, and also for the exhaustive preoperative workup done to correlate GERD symptoms and esophagitis. The authors also reported postoperative endoscopy in 7 patients showing the resolution of esophagitis. The RYGB is considered an antireflux procedure but many studies indicate that GERD symptoms persist after this procedure [3, 4]. There are many reasons accounting for what some may consider a paradox. First, GERD is rarely defined as strictly as in the study by Lim et al. Second, GERD is a heterogeneous condition going from erosive esophagitis and Barrett’s esophagus to functional heartburn with physiological reflux with negative symptoms association and reflux hypersensitivity with positive symptoms association. Interestingly, this is a continuous spectrum of conditions with a common denominator represented by the increasing acid reflux that culminates in patients with erosive esophagitis
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