Effect of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass on esophageal motility and gastroesophageal reflux at more than 5 years in patients with severe obesity.

Abstract

Background: The effect of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on postoperative esophageal motility and its clinical significance is poorly understood.

Objectives: To investigate the effect of SG and RYGB on esophageal motility and distal esophageal acid exposure time at least 5 years after surgery.

Setting: Prospective clinical study conducted in 2 academic hospitals in Switzerland.

Methods: Patients who underwent SG and RYGB were invited at least 5 years after surgery to undergo upper endoscopy, high-resolution manometry (HRM) and wireless pH measurement. Primary outcome was presence of esophageal motility disorders. Exploratory outcomes included presence of esophagitis, Barrett's esophagus, esophageal acid exposure, and validated symptom questionnaires.

Results: A total of 113 patients (49 SG and 64 RYGB) underwent HRM and pH monitoring 7 ± 1.6 years after bariatric-metabolic surgery. Integrated-relaxation-pressure was 4.3 ± 3.9 mm Hg after SG and 4.2 ± 3.8 mm Hg after RYGB (P = .89). Average distal contractile integral was 2931 ± 2102 mm Hg-cm-s after SG and 3530 ± 3454 mm Hg-cm-s after RYGB (P = .29). After 100-mL rapid drinking challenge, a hypercontractile or spastic contraction was seen in 37.5% after RYGB and 16.3% after SG (P = .01). Mean esophageal acid exposure time was 11.4 ± 7.9% after SG and 1.3 ± 2.1 after RYGB (P < .0001). Esophagitis was present in 67.3% after SG and 28.1% after RYGB (P < .0001).

Conclusions: Esophageal motility is similar for patients after SG and RYGB and clinically significant motility disorders of the esophagus are rare at long term follow-up. SG leads to significantly more reflux esophagitis, acid reflux and symptoms than RYGB and therefore, endoscopic surveillance should be considered.