6-Month Gastrointestinal Quality of Life (QoL) Results after Endoscopic Sleeve Gastroplasty and Laparoscopic Sleeve Gastrectomy: A Propensity Score Analysis (original) (raw)
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Obesity Surgery, 2017
Introduction Bariatric surgery is the only treatment option that achieves sustained weight loss in obese patients and that also has positive effects on obesity-related comorbidities. Laparoscopic sleeve gastrectomy (LSG) seems to achieve equal weight loss as laparoscopic Roux-en-Y gastric bypass (LRYGB), but there is still much debate about the quality of life (QOL) after LSG, mainly concerning the association with gastroesophageal reflux. Our hypothesis is that QOL after LSG is comparable with QOL after LRYGB. Materials and Methods Between February 2013 and February 2014, 150 patients were randomized to undergo either LSG or LRYGB in our clinic. Differences in QOL were compared between groups by using multiple QOL questionnaires at follow-up moments preoperatively and 2 and 12 months after surgery. Results After 12 months of follow-up, 128 patients had returned the questionnaires. Most QOL questionnaires showed significant improvement in scores between the preoperative moment and after 12 months of follow-up. The Gastroesophageal Reflux Disease Questionnaire (GerdQ) score deteriorated in the LSG group after 2 months, but recovered again after 12 months. After 2 months of follow-up, the mean GerdQ score was 6.95 ± 2.14 in the LSG group versus 5.50 ± 1.49 in the LRYGB group (p < 0.001). After 1 year, the mean GerdQ score was 6.63 ± 2.26 in the LSG group and 5.60 ± 1.07 in the LRYGB group (p = 0.001). Conclusion This randomized controlled trial shows that patients who underwent LSG have significantly higher GerdQ scores at both 2 and 12 months postoperatively than patients who underwent LRYGB, whereas overall QOL did not differ significantly.
Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients
Gastrointestinal Endoscopy, 2018
Background and Aims: Questions related to the safety and long-term efficacy of endoscopic sleeve gastroplasty (ESG) are not yet answered. Here we report weight loss, morbidity, revisions, and comorbidity resolution during the first 18 months after primary ESG. Methods: This is a consecutive case series from a prospective observational study executed in a specialized center with a standardized pathway for multimodal management of obesity. Results: The 1000 patients in this study had a baseline body mass index of 33.3 AE 4.5 kg/m 2 and age of 34.4 AE 9.5 years. Eight hundred ninety-seven patients (89.7%) were women. Mean percentage of total weight loss at 6, 12, and 18 months was 13.7% AE 6.8% (n Z 369; follow-up rate Z 423; 87.2%), 15.0% AE 7.7% (n Z 216; follow-up rate Z 232; 93.1%), and 14.8% AE 8.5% (n Z 54; follow-up rate Z 63; 85.7%), respectively. Lost to follow-up at the 12-and 18-month visits were 6.9% and 14.3%, respectively. Thirteen of 17 cases of diabetes, all 28 cases of hypertension, and 18 of 32 cases of dyslipidemia were in complete remission by the third month. With regard to postoperative complaints, 924 patients (92.4%) complained of nausea or abdominal pain that was controlled with medications during the first week after ESG. Twenty-four patients were readmitted: 8 for severe abdominal pain, of whom 3 had ESG reversal; 7 for postprocedure bleeding, 2 of whom received 2 units of packed red blood cells each; 4 for perigastric collection with pleural effusion, 3 of whom underwent percutaneous drainage; and 5 for postprocedure fever with no sequelae. Eight patients were revised to sleeve gastrectomy, and 5 had redo-ESG. No patient required an emergency intervention, and there were no mortalities. Conclusions: ESG appears to be well tolerated, safe, and effective. Significant weight loss occurs during the first 18 months without mortality or significant morbidity. Some patients require revision or reversal during the first year. (Gastrointest Endosc 2019;-:1-7.)
Long-term outcomes of laparoscopic sleeve gastrectomy as a definitive bariatric procedure
Surgery for Obesity and Related Diseases, 2010
Introduction Sleeve gastrectomy (LSG) is one of the most popular bariatric procedures. We present our long-term results regarding weight loss, comorbidities, and gastric reflux disease. Material and Methods We identified patients who underwent LSG in our institution between 2006 and 2009. We revised the data, and the patients with outdated contact details were tracked with the national health insurance database and social media (facebook). Each of the identified patients was asked to complete an online or telephone survey covering, among others, their weight and comorbidities. On that basis, we calculated the percent total weight loss (%TWL) and percent excess weight loss (%EWL), along with changes in body mass index (ΔBMI). Satisfactory weight loss was set at >50% EWL (for BMI = 25 kg/m 2). We evaluated type 2 diabetes (T2DM) and arterial hypertension (AHT) based on the pharmacological therapy. GERD presence was evaluated by the typical symptoms and/or proton pump inhibitor (PPI) therapy. Results One hundred twenty-seven patients underwent LSG between 2006 and 2009. One hundred twenty patients were qualified for this study. Follow-up data was available for 100 participants (47 female, 53 male). Median follow-up period reached 8.0 years (from 7.1 to 10.7). Median BMI upon qualification for LSG was 51.6 kg/m 2. Sixteen percent of patients required revisional surgery over the years (RS group), mainly because of insufficient weight loss (14 Roux-Y gastric bypass-LRYGB; one mini gastric bypass, one gastric banding). For the LSG (LSG group n = 84), the mean %EWL was 51.1% (±22.3), median %TWL was 23.5% (IQR 17.7-33.3%), and median ΔBMI was 12.1 kg/m 2 (IQR 8.2-17.2). Fifty percent (n = 42) of patients achieved the satisfactory %EWL of 50%. For RS group, the mean %EWL was 57.8% (±18.2%) and median %TWL reached 33% (IQR 27.7-37.9%). Sixty-two percent (n = 10) achieved the satisfactory weight loss. Fifty-nine percent of patients reported improvement in AHT therapy, 58% in T2DM. After LSG, 60% (n = 60) of patients reported recurring GERD symptoms and 44% were treated with proton pomp inhibitors (PPI). In 93% of these cases, GERD has developed de novo. Conclusions Isolated LSG provides fairly good effects in a long-term follow-up with mean %EWL at 51.1%. Sixteen percent of patients require additional surgery due to insufficient weight loss. More than half of the subjects observe improvement in AHT and T2DM. Over half of the patients complain of GERD symptoms, which in most of the cases is a de novo complaint.
Impact of Laparoscopic Sleeve Gastrectomy on Upper Gastrointestinal Symptoms
Obesity Surgery, 2013
Background Altered gastric anatomy following laparoscopic sleeve gastrectomy (LSG) is likely to induce upper gastrointestinal (GI) symptoms. Published studies, however, have focused mainly on gastroesophageal reflux disease (GERD). This study aims to evaluate LSG's impact on the prevalence of upper GI symptoms and to assess the effects of time from surgery, weight loss, and proton pump inhibitor (PPI) therapy. Methods The validated Rome III Criteria symptom questionnaire for upper GI symptoms, including quality of life items, has been self-administered to 97 patients who underwent LSG. Symptoms were analyzed either separately or altogether to classify patients in GERD or dyspepsia, subdivided in epigastric pain (EPS) and post-prandial distress (PDS) syndromes.
Clinical and Experimental Gastroenterology, 2019
Aim: To evaluate the value of esophagogastroduodenoscopy (EGD) as a preoperative investigation in individuals without symptoms of Gastro-Esophageal Reflux Disease (GERD) who will undergo laparoscopic sleeve gastrectomy (LSG). Materials and methods: After Institutional Review Board approval was obtained, patients scheduled for LSG were prospectively enrolled in the study between January 2016 and March 2018. Patients with symptoms of GERD were excluded from the study. Participants were randomly allocated to two groups: individuals who underwent EGD before the surgery as a usual routine investigation (Group A), and individuals who were scheduled without preoperative EGD (Group B). Patient demographics, endoscopic findings, endoscopic biopsy results, and histopathological findings of the resected parts of the stomach after LSG were analyzed and recorded. Additionally, operative characteristics and outcomes, and follow up findings were recorded and analyzed with appropriate statistical methods. Results: A total of 219 individuals without symptoms of GERD underwent LSG were enrolled. Group A included 111 individuals (25 males and 86 females). Group B comprised 108 individuals (20 males and 88 females). The mean age and mean Body Mass Index (BMI) were similar in both groups. From Group A, 86 out of 111 individuals (77.5%) had no pathology identified on EGD, while 21 individuals (18.9%) were found to have areas of gastric erythema and biopsies showed active gastritis. All LSG operations were performed without any major complication. After one year, all individuals were assessed for the presence of symptomatic GERD and no significant difference was found between the two groups. Conclusion: Preoperative EGD may not be mandatory for asymptomatic GERD individuals undergoing LSG as post-operative complications and early follow up for GERD symptoms are not significantly different. Further prospective studies with longer follow up are needed to evaluate the role of EGD in individuals undergoing LSG.
Success Predictors of Endoscopic Sleeve Gastroplasty
Obesity surgery, 2024
Objective Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that proved to be safe and effective in obesity treatment. However, not all subjects respond to treatment in the same way, and, with a view to personalized care, it is essential to identify predictors of success or failure. Methods A retrospective 2-year followed-up cohort of ESG subjects was analyzed to investigate the presence of any baseline or early indicators of long-term optimal or suboptimal ESG outcomes. Results A total of 315 subjects (73% women) were included, with 73% of patients exhibiting an Excess weight loss percentage (%EWL) >25% at the 24 months. Neither demographic parameters (age and sex), smoking habits, and menopause in women nor the presence of comorbidities proved potential predictive value. Interestingly, the %EWL at 1 month after ESG was the strongest predictor of 24-month therapeutic success. Subsequently, we estimated an "early threshold for success" for 1 month-%EWL by employing Youden's index method. Conclusions ESG is a safe and effective bariatric treatment that can be offered to a wide range of subjects. Early weight loss seems to impact long-term ESG results significantly and may allow proper early post-operative care optimization.
Biomedical Journal of Scientific and Technical Research, 2020
Purpose: GERD is one of the complications of bariatric operations that my affect quality of life. Our aim is to perform a retrospective cohort study to determine the incidence of symptomatic GERD following different types of bariatric surgery and which operations are considered a contraindication of GERD. In addition, we are attempting to identify the risk factors of GERD after bariatric surgery. Materials and Methods: Medical records of 729 patients hospitalized for bariatric surgery between January 2010 and June 2019 in Shamir (Assaf Harofeh) Medical Center were reviewed. Results: There were significant difference between the type of the bariatric procedure and the incidence of GERD symptoms after the operation. The incidence of symptomatic GERD in patients who underwent SG was 39.9% (p =0.0131). This was significantly higher comparing to 16.4% following roux en y gastric bypass, 23.4% following LAGB, and 11% following OAGB. 113 patients out of 718 had a positive swallow test and of these patient 71 developed GERD symptoms post-operatively without correlation to the degree of reflux at the swallow test but with statistically significant correlation to the type of operation especially for SG (P value <0.001) and to our knowledge this was never reported in the literature. Conclusion: SG is a good bariatric procedure option but should be contraindicated in asymptomatic reflux contrast swallow study and symptomatic GERD patients preoperatively because of high levels of symptomatic GERD post-operatively. Asymptomatic reflux at contrast swallow study pre-operatively should be considered a risk factor for GERD after the operation.
Obesity Surgery, 2020
Objective To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) on gastroesophageal reflux disease (GERD) in patients with obesity. Methods Patients with class II or III obesity were treated with LSG or LRYGB. Procedure choice was based on patients and surgeon preferences. GERD symptoms, endoscopy, barium swallow X-ray, esophageal manometry, and 24-h pH monitoring were obtained before and 1 year after surgery. Results Seventy-five patients underwent surgery (83% female, 39.3 ± 12.1 years, BMI of 41.5 ± 5.1 kg/m 2): 35 (46.7%) had LSG and 40 (53.3%) LRYGB. LSG patients had lower BMI (40.3 ± 4.0 kg/m 2 vs. 42.7 ± 5.7 kg/m 2 ; p = 0.041) and trend toward lower prevalence of GERD (20% vs. 40%; p = 0.061). One year after surgeries, GERD was more frequent in LSG patients (74% vs. 25%; p < 0.001) and all LSG patients with preoperative GERD continue to have GERD postoperatively. De novo GERD occurred in 19 of 28 (67.9%) of LSG patients and 4 of 24 (16.7%) patients treated with LRYGB (OR 10.6, 95%CI 2.78-40.1). Independent predictors for post-operative GERD were as follows: LSG (OR 12.3, 95%CI 2.9-52.5), preoperative esophagitis (OR 8.5, 95% CI 1.6-44.8), and age (OR 2.0, 95%CI 1.1-3.4). Conclusions One year after surgery, persistent or de novo GERD were substantially more frequent in patients treated with LSG compared with LRYGB. LSG was the strongest predictor for GERD in our trial. Preoperative counseling and choice of bariatric surgical options must include a detailed assessment and discussion of GERD-related surgical outcomes.
Obesity Surgery, 2012
Background Bariatric surgery is the most effective treatment for gastro-esophageal reflux disease (GERD) in obese patients, with the Roux-en-Y gastric bypass being the technique preferred by many surgeons. Published data reporting the results of laparoscopic sleeve gastrectomy (LSG) in patients with GERD are contradictory. In a previous observational study, we found that relative narrowing of the distal sleeve, hiatal hernia (HH), and dilation of the fundus predispose to GERD after LSG. In this study, we evaluated the effects of standardization of our LSG technique on the incidence of postoperative symptoms of GERD. Methods This was a concurrent cohort study. Patients who underwent bariatric surgery at our center were followed prospectively. LSG was performed in all patients in this series. Results A total of 234 patients underwent surgery. There were no cases of death, fistula, or conversion to open surgery. All 134 patients who completed 6-12 months of postoperative follow-up were evaluated. Excess weight loss at 1 year was 73.5 %. In the study group, 66 patients (49.2 %) were diagnosed with GERD preoperatively, and HH was detected in 34 patients (25.3 %) intraoperatively. HH was treated by reduction in three patients, anterior repair in 28, and posterior repair in three. Only two patients (1.5 %) had symptoms of GERD at 6-12 months postoperatively. Conclusions Our results confirm that careful attention to surgical technique can result in significantly reduced occurrence of symptoms of GERD up to 12 months postoperatively, compared with previous reports of LSG in the literature.
Gastrointestinal Quality of Life Following Laparoscopic Vertical Banded Gastroplasty
Obesity Surgery, 2002
Background: Laparoscopic vertical banded gastroplasty (LVBG) is a safe and effective treatment for morbid obesity. Previous studies disclosed a significant improvement in the health-related quality of life after substantial weight loss following VBG. Data regarding the specific gastrointestinal quality of life following LVBG is lacking. Materials and Methods: 223 patients who underwent LVBG for morbid obesity were studied prospectively. Quality of life was measured by the Gastrointestinal Quality of life Index (GIQLI), a 36item questionnaire before surgery, and at 6 months, 1 year and 2 years after surgery. The questionnaire is divided into 5 domains, and the maximum score is 144.