TY - JOUR
T1 - Gastroesophageal Reflux Disease Outcomes After Vertical Sleeve Gastrectomy and Gastric Bypass
AU - Leslie, Daniel
AU - Wise, Eric
AU - Sheka, Adam
AU - Abdelwahab, Hisham
AU - Irey, Ryan
AU - Benner, Ashley
AU - Ikramuddin, Sayeed
N1 - Publisher Copyright:
© 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Objective: The objective of this study is to assess whether vertical sleeve gastrectomy (VSG) increases the incidence of gastroesophageal reflux disease (GERD), esophagitis and Barrett esophagus (BE) relative to patients undergoing Roux-en-Y gastric bypass (RYGB) in patients with and without preoperative GERD. Summary of Background Data: Concerns for potentiation of GERD, supported by multiple high-quality retrospective studies, have hindered greater adoption of the VSG. Methods: From the OptumLabs Data Warehouse, VSG and RYGB patients with ≥2 years enrollment were identified and matched by follow-up time. GERD [reflux esophagitis, prescription for acid reducing medication (Rx) and/or diagnosis of BE], upper endoscopy (UE), and re-admissions were evaluated beyond 90 days. Results: Atotal of 8362 patients undergoing VSGwerematched 1:1 to patients undergoing RYGB, on the basis of post-operative follow-up interval. Age, sex, and follow-up time were similar between the 2 groups (P > 0.05). Among all patients, postoperative GERD was more frequently observed in VSG patients relative to RYGB patients (60.2% vs 55.6%, respectively; P < 0.001), whereas BE was more prevalent in RYGB patients (0.7% vs 1.1%; P = 0.007). Postoperatively, de novo esophageal reflux symptomatologywas more common in VSGpatients (39.3% vs 35.3%; P<0.001), although there was no difference in development of the histologic diagnoses reflux esophagitis and BE. Furthermore, postoperative re-admission was higher in the RYGB cohort (38.9% vs 28.9%; P < 0.001). Conclusions: Compared to RYGB, VSG may not have inferior long-term GERD outcomes, while also leading to fewer re-hospitalizations. These data challenge the prevailing opinion that patients with GERD should undergo RYGB instead of VSG.
AB - Objective: The objective of this study is to assess whether vertical sleeve gastrectomy (VSG) increases the incidence of gastroesophageal reflux disease (GERD), esophagitis and Barrett esophagus (BE) relative to patients undergoing Roux-en-Y gastric bypass (RYGB) in patients with and without preoperative GERD. Summary of Background Data: Concerns for potentiation of GERD, supported by multiple high-quality retrospective studies, have hindered greater adoption of the VSG. Methods: From the OptumLabs Data Warehouse, VSG and RYGB patients with ≥2 years enrollment were identified and matched by follow-up time. GERD [reflux esophagitis, prescription for acid reducing medication (Rx) and/or diagnosis of BE], upper endoscopy (UE), and re-admissions were evaluated beyond 90 days. Results: Atotal of 8362 patients undergoing VSGwerematched 1:1 to patients undergoing RYGB, on the basis of post-operative follow-up interval. Age, sex, and follow-up time were similar between the 2 groups (P > 0.05). Among all patients, postoperative GERD was more frequently observed in VSG patients relative to RYGB patients (60.2% vs 55.6%, respectively; P < 0.001), whereas BE was more prevalent in RYGB patients (0.7% vs 1.1%; P = 0.007). Postoperatively, de novo esophageal reflux symptomatologywas more common in VSGpatients (39.3% vs 35.3%; P<0.001), although there was no difference in development of the histologic diagnoses reflux esophagitis and BE. Furthermore, postoperative re-admission was higher in the RYGB cohort (38.9% vs 28.9%; P < 0.001). Conclusions: Compared to RYGB, VSG may not have inferior long-term GERD outcomes, while also leading to fewer re-hospitalizations. These data challenge the prevailing opinion that patients with GERD should undergo RYGB instead of VSG.
KW - Barrett’s esophagus
KW - GERD
KW - RYGB
KW - Rouxen-Y gastric bypass
KW - VSG
KW - acid reflux
KW - esophagitis
KW - gastroesophageal reflux disease
KW - heartburn
KW - vertical sleeve gastrectomy
UR - http://www.scopus.com/inward/record.url?scp=85117540073&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85117540073&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000005061
DO - 10.1097/SLA.0000000000005061
M3 - Article
C2 - 34506320
AN - SCOPUS:85117540073
SN - 0003-4932
VL - 274
SP - 646
EP - 653
JO - Annals of surgery
JF - Annals of surgery
IS - 4
ER -