BACKGROUND The Roux-en-Y gastric bypass (RYGB) isuery ID="Q1" Text="Author:Kindly check the edit made in the article title." -->the most efficacious procedure of choice for obese patients with gastroesophageal reflux disease (GERD). The laparoscopic sleeve gastrectomy (LSG) has high rates of worsening GERD post operatively. Little evidence exists as to whether the use of objective foregut investigations has a meaningful impact on surgical procedure selection. This study examined whether a standard preoperative foregut evaluation protocol effected procedure selection in bariatric patients presenting for surgical evaluation with subjective symptoms of GERD. METHODS Patients presenting for bariatric surgery evaluation with subjective symptoms of GERD entered into a predetermined protocol of foregut evaluation. Patients initially underwent upper endoscopy and esophagram. If the patient desired a LSG, further testing with esophageal pH testing and high-resolution manometry was ordered. If significant pathology was discovered on any of these investigations RYGB was recommended, if investigations were normal LSG was felt to be permissible. Data were collected prospectively from July 2016 to December 2018 and reviewed. RESULTS One hundred and thirty-three patients were identified as being eligible to have progressed through the protocol. Pathology was commonly discovered on preoperative evaluations. On EGD Barrett's esophagus was discovered in 4%, grade C or D esophagitis in 18% and hiatal hernia in 36% of patients. On esophagram, hiatal hernia was discovered in 42.3% of patients. Abnormal esophageal motility was discovered in 41% and abnormal DeMeester scores in 83% of tested patients. Of the 133 patients evaluated, the final procedure the patient ultimately underwent was primarily determined based on protocol test results in 24.8% of cases. CONCLUSIONS Foregut pathology is common in bariatric patients with subjective symptoms of GERD. Implementing a comprehensive protocol to objectively assess these patients leads to a significant clinical impact on which procedure these patients ultimately undergo.

中文翻译：

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优化减肥手术结果：在患有胃食管反流病的减肥人群中的一种新的术前方案。

背景 Roux-en-Y 胃绕道 (RYGB) isuery ID="Q1" Text="作者：请检查文章标题中所做的编辑。--> 对于患有胃食管反流病 (GERD) 的肥胖患者来说，最有效的手术选择。腹腔镜袖状胃切除术 (LSG) 术后胃食管反流病恶化率很高。很少有证据表明使用客观的前肠检查是否对外科手术选择有有意义的影响。这项研究检查了标准的术前前肠评估方案是否会影响因胃食管反流病主观症状而进行手术评估的减肥患者的手术选择。方法 因胃食管反流病主观症状而接受减肥手术评估的患者进入预定的前肠评估方案。患者最初接受了上消化道内窥镜检查和食管造影。如果患者需要 LSG，则需要进行进一步的食道 pH 测试和高分辨率测压。如果在这些调查中发现了明显的病理学，则建议使用 RYGB，如果调查正常，则认为 LSG 是允许的。前瞻性收集了 2016 年 7 月至 2018 年 12 月的数据并进行了审查。结果 133 名患者被确定为有资格通过该方案取得进展。病理学通常在术前评估中发现。在 EGD 上，4% 的患者发现 Barrett 食管，18% 的患者发现 C 或 D 级食管炎，36% 的患者发现食管裂孔疝。食管造影显示，42.3% 的患者发现食管裂孔疝。41% 的患者发现食管运动异常，83% 的患者发现 DeMeester 评分异常。在评估的 133 名患者中，患者最终接受的最终手术主要是根据 24.8% 的病例的方案测试结果确定的。结论 前肠病理在有胃食管反流病主观症状的减肥患者中很常见。实施一项全面的协议来客观地评估这些患者会对这些患者最终接受的程序产生重大的临床影响。