Gastroesophageal reflux diseaseand Barrett’s esophagusafter
laparoscopic sleevegastrectomy:apossible,underestimatedlong-term


This paper showed, because SG is performed in an increasing number of  patients, postoperative occurrence of EE and/or BE and its possible long-term sequelae should be carefully considered.  Furthermore, it is particularly worrisome that the data of the present study suggest that there is no strict relationship between  GERD symptoms and occurrence of EE and/or of BE. As a consequence, routine careful endoscopic evaluation in the postoperative surveillance of SG patients should be encouraged, regardless of presence or absence of GERD symptoms. Furthermore, improvements and/or modifications of the surgical technique, aimed to reduce esophageal reflux, should be pursued.

Morbidly obese patients are affected by gastroesophageal reflux disease (GERD) and hiatal hernia (HH) more frequently than lean patients [1]. Inturn, GERD and HH are associated with an increased incidence of Barrett’s esophagus (BE). In particular the duration and the degree of reflux symptoms, as well as the presence of HH, appear to bepositivelyrelatedtotheprevalenceofBE [2]. Furthermore, a high body mass index (BMI) and an increased amount of visceral fat represent 2 relevant risk factors for the development of BE, irrespective of the presence of GERD [3].

 Bariatric surgery proved to be the most effective and long-lasting therapeutic option for morbid obesity and its related diseases [4]. As a consequence the yearly number of surgical procedures progressively increased. In particular in the last decade laparoscopic sleevegastrectomy (SG) had an exponential growth [5].

Given these data, there is a mounting interest concerning the pathophysiological and clinical effects of bariatric surgery on GERD and its sequelae, aiming to define which surgical procedures, among those ones currently performed, may achieve better outcomes in this particular set of patients.

Laparoscopic Roux-en-Y gastric by pass (LRYGBP) is considered the intervention of choice, either as primary or revision procedure, in morbidly obese patients suffering of GERD with or without HH [6]. To the contrary the indication to SG in patients with GERD is still under debate. A postoperative improvement of reflux symptoms has been reported in some series, while in other series a worsening has been registered [7]. However, in most published studies, GERD diagnosis relies only on clinical symptoms evaluation whereas more objective diagnostic exams such as esophagogastroduodenoscopy (EGD), upper gastrointestinal radiographic swallow (UGI), scintigraphy, manometry metric impedance, or 24 pH-manometry are rarely involved [7].  In this paper incidence of GERD in morbidly obese patients before SG and at58 months’ follow-up will be evaluated on the basis ofclinical, endoscopic, and histologic data.



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