Effects of bariatric surgery on obesity associated gastroesophageal reflux disease: Insights from a systematic review and network meta-analysis

BACKGROUND: Obesity is a global epidemic frequently associated with gastroesophageal reflux disease (GERD). Metabolic and bariatric surgery (MBS) is the most effective treatment for weight reduction in patients with obesity, with the most commonly performed procedures being sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one-anastomosis gastric bypass (OAGB). Many recent studies focused on determining the best procedure for patients with obesity and GERD; however, results from these studies vary, and the optimal procedure remains uncertain. AIM: To compare the effects of MBSs - SG, RYGB, and OAGB - and their combinations with antireflux procedures on weight loss and GERD outcomes. METHODS: A systematic search was performed to identify randomized controlled trials evaluating MBS in patients with obesity and GERD. A network meta-analysis was conducted to estimate the relative effectiveness of different procedures on body mass index reduction, percent excess weight loss, GERD remission, GERD onset, postoperative proton pump inhibitor use, esophagitis, and complication rates. OAGBantiflux showed the highest body mass index reduction, and OAGB and RYGB had similar efficacies. In terms of percent excess weight loss, OAGB and RYGB ranked higher than other MBSs, whereas SGantiflux was the least effective. RYGB had the highest probability of GERD remission, followed by SG, SGantiflux, OAGB, and OAGBantiflux. SGantiflux showed the highest probability of the postoperative GERD onset, while SG was most likely to require postoperative proton pump inhibitor use and cause esophagitis. SGantiflux also demonstrated the highest complication rate, whereas OAGBantiflux was associated with the lowest, with OAGB, RYGB, and SG yielding intermediate rates in a descending order. CONCLUSION: RYGB and OAGB were more effective than SG in patients with obesity and GERD, and addition of antireflux procedures to MBS did not improve GERD outcome.