Gastroesophageal reflux disease, obesity and laparoscopic sleeve gastrectomy: The burning questions

Obesity is a global health epidemic with considerable economic burden. Surgical solutions have become increasingly popular following technical advances leading to sustained efficacy and reduced risk. Sleeve gastrectomy accounts for almost half of all bariatric surgeries worldwide but concerns regard...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2019-09, Vol.25 (33), p.4805-4813
Main Authors: Bou Daher, Halim, Sharara, Ala I
Format: Article
Language:English
Subjects:
Endoscopy, Gastrointestinal
Esophagitis - epidemiology
Esophagitis - etiology
Gastric Bypass - adverse effects
Gastric Bypass - methods
Gastroesophageal Reflux - diagnosis
Gastroesophageal Reflux - epidemiology
Gastroesophageal Reflux - etiology
Gastroplasty - adverse effects
Gastroplasty - methods
Humans
Laparoscopy - adverse effects
Laparoscopy - methods
Obesity, Morbid - surgery
Opinion Review
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Preoperative Period
Prevalence
Time Factors
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Summary:Obesity is a global health epidemic with considerable economic burden. Surgical solutions have become increasingly popular following technical advances leading to sustained efficacy and reduced risk. Sleeve gastrectomy accounts for almost half of all bariatric surgeries worldwide but concerns regarding its relationship with gastroesophageal reflux disease (GERD) has been a topic of debate. GERD, including erosive esophagitis, is highly prevalent in the obese population. The role of pre-operative endoscopy in bariatric surgery has been controversial. Two schools of thought exist on the matter, one that believes routine upper endoscopy before bariatric surgery is not warranted in the absence of symptoms and another that believes that symptoms are poor predictors of underlying esophageal pathology. This debate is particularly important considering the evidence for the association of laparoscopic sleeve gastrectomy (LSG) with and/or worsening GERD compared to the less popular Roux-en-Y gastric bypass procedure. In this paper, we try to address 3 burning questions regarding the inter-relationship of obesity, GERD, and LSG: (1) What is the prevalence of GERD and erosive esophagitis in obese patients considered for bariatric surgery? (2) Is it necessary to perform an upper endoscopy in obese patients considered for bariatric surgery? And (3) What are the long-term effects of sleeve gastrectomy on GERD and should LSG be done in patients with pre-existing GERD?
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v25.i33.4805