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OUTCOMES OF CONVERSION OF SLEEVE GASTRECTOMY TO ROUX-EN-Y GASTRIC BYPASS FOR THE TREATMENT OF GERD
Michael Cymbal
*, Renan Prado, Leandro Sierra, Arjun Chatterjee, Stephen Firkins, Roma Patel, Akash T. Khurana, Bailey Flora, Erika Staneff, Roberto Simons-Linares
Internal Medicine, Cleveland Clinic, Cleveland, OH
Background: Gastroesophageal reflux disease (GERD) is a common complication following sleeve gastrectomy (SG). Conversion to Roux-en-Y gastric bypass (RYGB) an effective surgical treatment option. The aim of this study was to evaluate the effect of conversion from SG to RYBG on GERD severity.
Methods: We conducted retrospective cohort analysis to identify adult patients who underwent SG who subsequently underwent conversion to RYGB due to de novo GERD from July, 2004 to August, 2024. Patients who were lost to follow up, underwent RYGB without GERD or those with achalasia were excluded. The primary outcome was rate of GERD improvement following conversion, defined as a decrease in proton pump inhibitor (PPI), improvement on endoscopic assessment (decrease in LA grade or Prague Classification), or esophageal pH testing. Secondary outcomes included GERD improvement stratified by total body weight loss, additional anatomic surgical repair (cruroplasty and/or hiatal hernia repair) at timer of RYGB, and presence of objective data meeting GERD diagnostic criteria prior to RYGB. Statistical analyses included t-tests for continuous variables, chi-square test for categorical variables, and univariate logistic regression to assess predictors of GERD resolution.
Results: Among 130 patients identified, 111 met criteria for final inclusion. GERD improved in 43.2% (48 patients) following surgical conversion to RYGB. Of those, 41 patients (85.4%) met criteria for improvement based on PPI reduction, with 22 (45.8%) completely discontinuing PPI use. Factors such as age, race, body mass index (BMI), smoking history, and alcohol use did not significantly differ between those whose GERD improved and those whose did not, except smoking pack-years (p=0.002). Additionally, those who met objective diagnosis for GERD prior to conversion showed significantly greater rates of improvement compared to those who did not (60% vs 33.8%, p = 0.006). No statistical significance was appreciated between GERD improvement and additional anatomical surgical repair during RYGB (p=0.52) or total body weight loss (p=0.35).
Conclusions: In patients with prior SG who developed GERD, conversion to RYGB objectively improved GERD in 43.2% of cases. Notably, many patients proceed to surgical conversion without meeting objective diagnostic criteria for GERD. This is paramount as those who meet objective diagnostic criteria for GERD exhibit a greater rate of improvement with surgical conversion, which may assist in patient selection, education and optimize outcomes.
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