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Optimizing bariatric surgery outcomes: a novel preoperative protocol in a bariatric population with gastroesophageal reflux disease

  • 2019 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

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.

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Acknowledgements

We would like to acknowledge Debra Allan, MSN, CBN and the entire bariatric team at the University of Iowa Hospitals and Clinics.

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  1. Roy J. and Lucille A. Carver College of Medicine, 4626 JCP, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Rhys Kavanagh, Jessica Smith, Umair Bashir, Dana Jones, Emily Avgenakis & Peter Nau

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  1. Rhys Kavanagh
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Correspondence to Peter Nau.

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Rhys Kavanagh, Jessica Smith, Umair Bashir, Dana Jones, Emily Avgenakis and Peter Nau have no conflicts of interest or financial ties to disclose.

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Kavanagh, R., Smith, J., Bashir, U. et al. Optimizing bariatric surgery outcomes: a novel preoperative protocol in a bariatric population with gastroesophageal reflux disease. Surg Endosc 34, 1812–1818 (2020). https://doi.org/10.1007/s00464-019-06934-4

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  • DOI: https://doi.org/10.1007/s00464-019-06934-4

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