应用食管功能试验（EFTs）对腹腔镜下食管括约肌压力（LESP）、下食管括约肌长度（LESL）和胃食管反流病（GERD）的影响：系统回顾和荟萃分析。

IF 3.8 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

International Journal of Obesity Pub Date : 2025-10-06 DOI:10.1038/s41366-025-01926-y

Muhammed Ashraf Memon, Rossita Mohamad Yunus, Khorshed Alam, Zahirul Hoque, Shahjahan Khan

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引用次数: 0

摘要

背景：LVSG似乎增加了胃食管反流的风险，尽管体重明显减轻。我们比较了术前和术后食管功能测试数据（结合BMI损失），以评估lvsg后对食管下括约肌压力（LESP）、食管下括约肌长度（LESL）和DeMeester评分（DMS）的影响。方法：从1999年至2023年的电子数据库中，对食管压力测量±24 h ph -研究前后lvsg的文章进行鉴定。采用队列研究关键评估技能项目清单进行质量评估。采用DerSimonian和Laird随机效应模型进行连续数据分析。采用Cochrane Q统计量和I2指数评估异质性。进行敏感性分析以评估我们分析的稳健性和有效性。Egger检验用于评估meta分析中潜在的发表偏倚。结果：19项研究共668例患者被评估（F = 445, M = 131）。根据16项研究，LVSG后LESP显著降低3.82 mm Hg （WMD 3.82, 95% CI 1.74, 5.90; p 2 = 88.6%）。基于9项研究，LESL未显示lvsg前后有显著差异（WMD 0.05, 95% CI -0.15, 0.26; p = 0.625, I2 = 83.1%）。12项研究显示LVSG后DMS显著增加11.72 （WMD -11.72, 95% CI -17.15至-6.30;p = 91.5%）。基于12项研究，LVSG后BMI显著下降13.26 kg/m2 （WMD为13.26,95% CI为11.65 ~ 14.88,Z = 16.07, p）。结论：LVSG与LVSG后LESP显著降低和DMS显著升高相关，尽管BMI显著降低，但导致新的GERD症状恶化或发展。我们的荟萃分析的局限性包括样本量小、随访时间短、异质性、缺乏一些混杂因素的数据以及一些研究的质量不足。

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Impact of laparoscopic vertical sleeve gastrectomy (LVSG) on lower esophageal sphincter pressure (LESP), lower esophageal sphincter length (LESL) and gastroesophageal reflux disease (GERD) using esophageal function tests (EFTs): a systematic review and meta-analysis.

Background: LVSG seems to increase the risk of GERD despite significant weight loss. We compared pre- and postoperative esophageal function test data (in conjunction with the BMI loss) to evaluate the impact of post-LVSG on lower esophageal sphincter pressure (LESP), lower esophageal sphincter length (LESL), and DeMeester Score (DMS).

Methods: Articles analyzing esophageal manometry ±24 h pH-study pre- and post-LVSG were identified using electronic databases from 1999 to 2023. The Critical Appraisal Skills Programme Checklist for Cohort Studies was used for quality assessment. The DerSimonian and Laird random effects model was used for continuous data analysis. Heterogeneity was assessed using the Cochrane Q statistic and I² index. Leave one out sensitivity analysis was undertaken to assess the robustness and validity of our analysis. Egger's test was used to evaluate potential publication bias in our meta-analysis.

Results: Nineteen studies totaling 668 patients were evaluated (F = 445, M = 131). A significant reduction of 3.82 mm Hg in LESP was observed after LVSG based on 16 studies (WMD 3.82, 95% CI 1.74, 5.90; p < 0.001, I² = 88.6%). LESL did not reveal any significant difference between pre- and post-LVSG based on nine studies (WMD 0.05, 95% CI -0.15, 0.26; p = 0.625, I² = 83.1%). DMS showed a significant increase of 11.72 post LVSG based on 12 studies (WMD -11.72, 95% CI -17.15 to -6.30; p < 0.001, I² = 91.5%). Significant BMI loss of 13.26 kg/m² was observed post LVSG based on 12 studies (WMD 13.26, 95% CI 11.65 to 14.88, Z = 16.07, p < 0.001).

Conclusions: LVSG is associated with a significant decrease in LESP and a significant increase in the DMS post-LVSG, leading to the worsening or development of new GERD symptoms despite significant BMI reduction. The limitations of our meta-analysis include small sample sizes, short follow-up, heterogeneity, lack of data on some confounders and inadequate quality of some studies.

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来源期刊

International Journal of Obesity 医学-内分泌学与代谢

CiteScore

10.00

自引率

2.00%

发文量

221

审稿时长

3 months

期刊介绍： The International Journal of Obesity is a multi-disciplinary forum for research describing basic, clinical and applied studies in biochemistry, physiology, genetics and nutrition, molecular, metabolic, psychological and epidemiological aspects of obesity and related disorders. We publish a range of content types including original research articles, technical reports, reviews, correspondence and brief communications that elaborate on significant advances in the field and cover topical issues.