Gastroesophageal reflux-related physiologic changes after sleeve gastrectomy and Roux-en-Y gastric bypass: a prospective comparative study
Gastroesophageal reflux-related physiologic changes after sleeve gastrectomy and Roux-en-Y gastric bypass: a prospective comparative study
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DOI：
10.1016/j.soard.2019.05.017
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发表时间：
2019-08-01
影响因子：
3.1
通讯作者：
Palanivelu, C.
中科院分区：
文献类型：
--
作者：
Raj, P. Praveen;Bhattacharya, Siddhartha;Palanivelu, C.
背景：腹腔镜袖胃切除术（LSG）后胃食管反流病（GERD）的发展是一个主要关注的问题，因为它影响患者的生活质量，并可能使他们暴露于GERD的并发症。据报道，LSG术后胃食管反流发生率高达35%。腹腔镜Roux-en-Y胃旁路术（LRYGB）被认为是病态肥胖合并胃食管反流患者的首选手术，但基于生理学研究的客观证据有限。目的：本研究的目的是通过LSG和LRYGB后的症状指数、24小时pH值、阻抗和血压测定来确定胃食管反流相关的生理变化。环境：三级护理教学医院，印度。方法：本注册研究（CTRI/2017/06/008834）是一项前瞻性、非随机、开放标签的临床试验，比较LSG和LRYGB术后胃食管反流发生率。在这项研究中，非GERD患者通过临床问卷、24小时pH值研究、术前和术后6个月阻抗测压来评估GERD。结果：30例行LSG， 16例行LRYGB。平均DeMeester评分由10.9 +/- 11.8上升至40.2 +/- 38.6 （P = 0.006）。LSG术后胃反流发生率为66.6%。LRYGB后DeMeester评分由9.5 +/- 4.6上升至12.2 +/- 17.2，差异无统计学意义（P = 0.7）。在LSG和LRYGB治疗后，非酸反流显著增加。结论：LSG术后胃食管反流发生率高，为LSG的禁忌症。LRYGB仍然是胃食管反流患者的首选手术。然而，需要更多的研究来了解已经存在的胃食管反流患者的生理变化。(C) 2019年美国减肥外科学会。Elsevier Inc.出版。版权所有。
Background: The development of gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) is a major concern as it affects the quality of life of the patients and potentially exposes them to the complications of GERD. The reported incidence of GERD after LSG is up to 35%. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the procedure of choice for patients with morbid obesity with GERD but objective evidence based on physiologic studies for the same are limited.Objective: The objectives of the study were to determine the physiologic changes related to gastroesophageal reflux based on symptoms index, 24-hour pH study, impedance, and manometry after LSG and LRYGB.Settings: Tertiary care teaching hospital, India.Methods: This registered study (CTRI/2017/06/008834) is a prospective, nonrandomized, open-label clinical trial comparing the incidence of GERD after LSG and LRYGB. In this study, non-GERD patients were evaluated for GERD based on clinical questionnaires, 24-hour pH study, and impedance manometry preoperatively and 6 months postoperatively.Results: Thirty patients underwent LSG, and 16 patients underwent LRYGB. The mean DeMeester score increased from 10.9 +/- 11.8 to 40.2 +/- 38.6 (P = .006) after LSG. The incidence of GERD after LSG was 66.6%. The increase in DeMeester score from 9.5 +/- 4.6 to 12.2 +/- 17.2 after LRYGB was not significant (P = .7). There was a significant increase in the nonacid reflux both after LSG and LRYGB.Conclusion: The incidence of GERD after LSG is high, making it a contraindication for LSG. LRYGB remains the preferred procedure for patients with GERD. However, more studies are needed to understand the physiologic changes in patients with preexisting GERD. (C) 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.