Manometric and pH-monitoring changes after laparoscopic sleeve gastrectomy: a systematic review

Abstract

Purpose Aim of this systematic review is to assess the changes in esophageal motility and acid exposure of the esophagus through esophageal manometry and 24-hours pH-monitoring before and after laparoscopic sleeve gastrectomy (LSG). Methods Articles in which all patients included underwent manometry and/or 24-hours pH-metry or both, before and after LSG, were included. The search was carried out in the PubMed, Embase, Cochrane, and Web of Science databases, revealing overall 13,769 articles. Of these, 9702 were eliminated because they have been found more than once between the searches. Of the remaining 4067 articles, further 4030 were excluded after screening the title and abstract because they did not meet the inclusion criteria. Thirty-seven articles were fully analyzed, and of these, 21 further articles were excluded, finally including 16 articles. Results Fourteen and twelve studies reported manometric and pH-metric data from 402 and 547 patients, respectively. At manometry, a decrease of the lower esophageal sphincter resting pressure after surgery was observed in six articles. At 24-hours pH-metry, a worsening of the DeMeester score and/or of the acid exposure time was observed in nine articles and the de novo gastroesophageal reflux disease (GERD) rate that ranged between 17.8 and 69%. A meta-analysis was not performed due to the heterogeneity of data. Conclusions After LSG a worsening of GERD evaluated by instrumental exams was observed such as high prevalence of de novo GERD. However, to understand the clinical impact of LSG and the burden of GERD over time further long-term studies are necessary.

Indocyanine Green Fluorescence Angiography During Laparoscopic Bariatric Surgery: A Pilot Study

“…Routine preoperative manometry, pH-metry and Rx-esophagogram were performed in accordance with Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) restrictions and patient compliance ( 41 , 42 ). A De Meester score greater than 14.7 at pH-metry was considered abnormal.…”

Does Sleeve Gastrectomy Worsen Gastroesophageal Reflux Disease in Obese Patients? A Prospective Study

“…14-17,33 This means that many patients with misdiagnosed GERD still undergo LSG, and this may be one of the causes of the controversial data on GERD after LSG that are reported in the literature. 29,30,35,36…”

The Impact of Bariatric Procedures on Esophageal Motility

“…LES resting pressure seems to decrease after sleeve gastrectomy, according to 2 recent systematic reviews, 61,62 although other studies did not show changes. 40,41 An interesting theory to explain the decreased LES pressure is that sling fibers may be partially resected if the staple line is close to the angle of His, 63 as shown by a significant decrease in LES length after the operation.…”

“…Peristalsis also seems to be altered after sleeve gastrectomy. 35,62 This may occur secondary to the high incidence of postoperative GERD. Some cases of pseudo-achalasia in symptomatic patients have also been described.…”