Association Between Cholecystectomy and Gastroesophageal Inflammatory Findings After Sleeve Gastrectomy: Endoscopic and Metabolic Evaluation

INTRODUCTION: Sleeve gastrectomy (SG) is associated with the development or worsening of gastroesophageal reflux disease (GERD). Cholecystectomy following SG - the standard treatment for cholelithiasis resulting from rapid weight loss - may influence GERD pathophysiology by enhancing enterohepatic bile circulation and increasing alkaline reflux. OBJECTIVE: To investigate the longitudinal development of endoscopic and histologic esophageal and gastric mucosal findings, alongside systemic metabolic profiles, across defined pre- and post-cholecystectomy intervals in individuals previously managed with SG. METHODS: A longitudinal, retrospective, observational cohort study was conducted with 133 patients who underwent cholecystectomy after SG between 2009 and 2017. Endoscopic findings were analyzed at three time points: pre-SG, pre-cholecystectomy, and post-cholecystectomy. RESULTS: Compared with the pre-sleeve gastrectomy assessment, moderate esophagitis increased from 3.0% to 12.2% and severe esophagitis from 0.8% to 2.7% at the post-cholecystectomy evaluation. In contrast, the direct comparison between the pre- and post-cholecystectomy assessments demonstrated a significant increase in gastric inflammatory findings, particularly moderate gastritis. Gastritis prevalence increased from 33.9% to 51.4% (p < 0.05), with moderate to severe cases rising from 11.9% to 23.0% (p < 0.05). BMI and metabolic parameters (HbA1c, insulin, fasting glucose, cholesterol, triglycerides, uric acid, and C-peptide) improved significantly (p < 0.001). CONCLUSION: Cholecystectomy following sleeve gastrectomy was associated with an increased prevalence and severity of gastritis and a progressive trend in esophagitis over time, without compromising the long-term metabolic benefits of SG.