The Impact of the Gastric Twist on Esophagitis Progression After Sleeve Gastrectomy: Mid-Term Endoscopic Findings
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ORIGINAL CONTRIBUTIONS
The Impact of the Gastric Twist on Esophagitis Progression After Sleeve Gastrectomy: Mid-Term Endoscopic Findings Álvaro A. B. Ferraz 1,2 & José-Tarcísio Dias da Silva 2 & Fernando Santa-Cruz 3 & Maria-Améllia R. Aquino 3 & Luciana T. Siqueira 1,2 & Flávio Kreimer 2 Received: 15 April 2020 / Revised: 1 July 2020 / Accepted: 6 July 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To determine the real influence of the gastric twist on the progression of esophagitis after SG, evaluating pre- and late post-operative endoscopic findings. Material and Methods We retrospectively included 459 patients submitted to SG between 2009 and 2019. The sample comprised patients who performed esophagogastroduodenoscopy (EGD) at the pre-operative and late post-operative periods. Results Patients were mainly female (85.6%), with a mean age of 40.4 years. Mean follow-up time was 20.8 months. In the preoperative period, 1.1% of patients had non-erosive esophagitis, 24.2% of patients had grade A erosive esophagitis, and 1.5% of patients had grade B. In the post-operative evaluation, 3.3% had non-erosive esophagitis, 14.8% presented grade A erosive esophagitis, 8.9% had grade B, and 1.3% had grade C esophagitis. There were no cases of Barrett’s esophagus. Forty-nine patients (10.7%) presented gastric twist. Comparing patients with and without gastric twist, it was possible to observe that the gastric twist group presented a higher incidence of grade C esophagitis (4.0% × 1.0%), p = 0.017. The correlation between the occurrence of gastric twist and esophagitis progression showed a prevalence ratio of 1.36 (95% CI 0.82–2.25). Conclusions SG is responsible for an increase in the prevalence of erosive esophagitis, and the occurrence of gastric twist definitely plays a role on it, expressing a risk of 36% for esophagitis progression and being related to a higher incidence of severe esophagitis. Keywords Bariatric surgery . Sleeve gastrectomy . Gastroesophageal reflux disease . Esophagitis . Gastric twist
Introduction Obesity is one of the most important risk factors for gastroesophageal reflux disease (GERD), with incidences ranging from 22 to 70% [1]. Patients with obesity present a high intra-abdominal pressure and, consequently, an increased gastroesophageal pressure gradient, that contributes to the onset of pathological reflux [2, 3].
Currently, bariatric surgery is the most effective approach for massive weight loss and remission of comorbidities in obese patients [4]. Therefore, it would be plausible to assume that, after surgery, specifically after weight loss, patients should experience improvements in their reflux symptoms. In fact, there is well-established evidence that RYGB reduces GERD symptoms and its complications significantly [5].
* Álvaro A. B. Ferraz [email protected] José-Tarcísio Dias da Silva [email protected] Fernando Santa-Cruz [email protected]
Flávio Kreimer [email protected] 1
Gastrointestinal Surgery Unit, Hos
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