Interventions for the Management of Post–Sleeve GERD

Abstract

AbstractOver the last decade, sleeve gastrectomy (SG) has steadily gained popularity and has now become the most commonly performed bariatric procedure in the United States. It is technically less complex than Roux-en-Y gastric bypass (RYGB) or biliopancreatic diversion with duodenal switch and has relatively good weight loss results in addition to comorbidity resolution. The long-term complication profile is appealing to patients and surgeons alike, save one issue, gastroesophageal reflux disease (GERD). GERD is frequently seen in bariatric surgery patients; thus, proper patient selection for SG is paramount. However, SG effects on GERD remain controversial in the literature. Thus, patients are intensively cautioned of the possibility of de novo GERD or worsening of already existing GERD following SG. Therefore, it is imperative that the discussion also occurs regarding potential treatment options if GERD does occur. GERD management following SG consists of a multitude of options. While lifestyle modifications and proton pump inhibitors remain the initial treatment of choice, some will have persistent symptoms needing additional interventions, which may range from a variety of endoscopic techniques (lower esophageal sphincter [LES], radiofrequency ablation, magnetic LES augmentation, and antireflux mucosectomy) to ReSleeve and ultimately conversion to RYGB.