Outcomes of Conversion from Sleeve Gastrectomy to Roux-en-Y Gastric Bypass for the Treatment of Gastroesophageal Reflux Disease

Abstract:Background Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure in the U.S., but it is associated with an increased risk of de novo or worsened gastroesophageal reflux disease (GERD). Conversion to Roux-en-Y gastric bypass (RYGB) is considered the gold standard for treating refractory GERD after SG, though objective outcomes remain underreported. Objectives To evaluate the efficacy of conversion from SG to RYGB for medically refractory GERD using objective measures of improvement. Secondary objectives included assessing whether weight loss, additional anatomic repairs, or application of updated American College of Gastroenterology (ACG) GERD diagnostic criteria impacted outcomes. Setting Academic tertiary care center (Cleveland Clinic Foundation, Cleveland, Ohio, United States). Methods A retrospective cohort study was conducted on patients who underwent SG followed by RYGB for refractory GERD from July 2004 to August 2024. GERD improvement was defined as decreased use of proton pump inhibitors (PPIs), endoscopic, or pH testing improvement. Logistic regression and chi-square analyses were used to assess predictors of improvement. Results Of 117 patients, 53 (45.3%) showed objective GERD improvement post-RYGB. Most improved via reduction in PPI OE (88.7%), of which 35.8% discontinued PPIs completely. Neither total body weight loss (P = .257) nor concurrent anatomical repairs (P = .615) correlated with GERD improvement. Meeting new ACG GERD diagnostic criteria was significantly associated with improvement (63.6% vs 33.3%, P = .03). Conclusion Conversion to RYGB results in objective GERD improvement in nearly half of patients undergoing conversion, independent of weight loss or anatomical repairs. ACG diagnostic criteria may help predict which patients benefit most. Prospective studies are needed to validate findings and refine surgical decision-making.