Impact of Sleeve Gastrectomy on Esophageal Physiology and Gastro-Esophageal Reflux Disease: A Bicentric Prospective Study

Document Type : Original Article

Authors

1 Department of Upper Gastrointestinal and Liver Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

2 Department of Surgical Sciences, University of Turin, Turin, Italy

Abstract

Background: Obesity is associated with gastroesophageal reflux disease and esophageal dysmotility. Bariatric surgeries
like laparoscopic sleeve gastrectomy (LSG) aid weight loss but can affect esophageal function. This study examines the
impact of LSG on esophageal physiology, especially concerning reflux.
Patients and methods: This prospective study, conducted between 2022 and 2023 in Egypt and Italy, involved 15 patients with severe obesity who had undergone LSG. The study used conventional esophageal manometry, 24-hour impedancepH monitoring, upper gastrointestinal series, gastroscopy, and a validated questionnaire pre and postoperatively to assess outcomes related to esophageal and lower esophageal sphincter (LES) functions and reflux.
Results: The study group after 1 year experienced significant reductions in weight and BMI, with P values less than
0.001 for both measures. Gastroesophageal reflux disease symptoms remained unchanged postoperatively (P=0.687) with
26.7% using proton pump inhibitors before and after surgery, and quality of life improved significantly, with a P value of
0.001. No significant changes were detected in the esophagogastroduodenoscopy, barium studies, and the metrics of the
multichannel intraluminal impedance-pH monitoring. Regarding the manometric parameters, significant changes were
observed as the total LES length decreased from 34.0 to 31.33 mm (P=0.027), LES residual pressure increased from 2.0
to 4.0 mmHg (P=0.012), and esophageal peristaltic wave amplitude decreased from 98.20 to 52.93 mmHg (P<0.001).
Conclusions: LSG is effective for weight loss and improving the quality of life. It controls reflux, with new cases being
uncommon. Advanced diagnostics are key when standard tests are insufficient.

Keywords

The Egyptian Journal of Surgery
Volume 44, Issue 2
April 2025
Pages 603-614

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