Introduction: Obesity is a multifactorial and chronic disease. Bariatric surgery (BS) is the most effective treatment. A prevalence of 45% of esophagitis and 40%-70% of gastritis after BS has been reported. We analysed the presence of gastroesophageal lesions in patients who underwent BS (By-pass Roux-en-Y(BP) and gastric sleeve(GS)) in our centre.
Methods: Patients submitted to BS between 2018-2020 were included. We retrospectively analysed clinical data, upper gastrointestinal endoscopy (UGE) and histologic results preoperatively and 12 months(M) after surgery. All patients underwent UGE and helicobacter pylori(HP) was eradicated if present. Protons pump inhibitors (PPI) were prescribed to all patients, until 6 M post-op. and maintained if upper gastric symptoms(UGS). Endoscopic esophageal and gastric lesions were categorised based on Los Angeles and Sydney classification.
Results: 32 patients (56% males) were included with mean age of 52±8.5 years-old and BMI of 41±4.4 kg/m2. Mean follow-up was 29.4±9.3 M. 71.9% patients performed BP and 28% GS. At pre-op.:53% had positive HP, 21.9% had UGS and 21% were on PPI treatment. Class A or B esophagitis was diagnosed in 15.7% and erythematous gastritis in 78% of patients. Histologic results confirmed gastritis in 68.8%. 12 M after BS patients had a mean BMI of 28±3.7 kg/m2 and 81.3% had no UGS. UGE revealed a total of class A or B esophagitis of 25%, in which 75% of the cases was de-novo lesion (83% submitted to GS and 33% had UGS). A significant reduction in erythematous gastritis was achieved in the corpus (18.8%; P=0.05) but not in the antrum (25%;P=0.22). 15.6% presented with de-novoulcer (all of them underwent BP). Biopsy confirmed gastritis in 43.7%(P=0.85). 1 case of Barretts esophagus was diagnosed but no cases of dysplasia. No significant association was found between histologic result(P=0.537) or PPI use (P=0.654), and BS procedure.
Conclusion: This study illustrates the importance of endoscopic follow-up of patients after BS, even if no UGS are present. After 12 M esophagitis was more prevalent, suggesting it was appropriate to maintain PPI use, in particular in those submitted to GS. A tendency to reduction was identified in gastric lesions.
21 May 2022 - 24 May 2022