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Abstract: After sleeve gastrectomy (SG), patients may develop gastroesophageal reflux disease (GERD), leading to severe complications like erosive esophagitis (EE), long-term use of proton-pump inhibitors, Barrett's esophagus (BE), and in rare cases, esophageal adenocarcinoma. Therefore, conducting regular surveillance through endoscopy is essential to detect any potential issues, even if there are no apparent symptoms. Upper gastrointestinal endoscopy (UGE) and contrast studies are recommended to diagnose GERD after SG. Identifying anatomical complications is crucial for patients experiencing reflux symptoms after SG. If no anatomical issues are detected, the first course of treatment is medical management with proton-pump inhibitors. If symptoms persist, the dose may escalate, and de-escalation may occur if symptoms improve. pHmetry and manometry can be utilized to identify underlying issues if proton-pump inhibitors are ineffective. When necessary, Roux-en-Y gastric bypass is the preferred treatment. Though emerging techniques like the Stretta procedure and Linx system are being evaluated for their less invasive approach to managing GERD after SG, their data still needs to be conclusive. Even in asymptomatic patients, continuous screening, including routine upper endoscopy, is necessary for long-term follow-up of GERD after SG. Management may require a combination of medical and surgical interventions, and less invasive approaches still require further research.
Serra et al. (Fri,) studied this question.