LVSG has a detrimental effect on lower oesophageal sphincter pressure and DeMeester Score post-surgery

The first meta-analysis to analyse objective oesophageal function data comparing pre- and post- laparoscopic vertical sleeve gastrectomy (LVSG), has conclusively demonstrated the detrimental effect of LVSG on lower esophageal sphincter pressure (LESP) and DeMeester Score (DMS) post-surgery despite significant loss of BMI, researchers from the University of Southern Queensland, Toowoomba, Queensland, Australia.

Research has shown that LVSG leads to anatomical changes at the esophagogastric junction (EGJ), which in turn leads to physiological consequences such as an increased risk of GERD or even the appearance of de novo GERD due to LES dysfunction despite significant weight loss.

However, assessing the effect of GERD after LVSG lacks standardised reporting, varying definitions, and often lack of objective assessment with oesophageal function tests (OFTs) such as manometry and 24 h pH study. As a result, the researchers conducted a systematic literature search and an in-depth review of the effect of LVSG and its impact on LES and subsequent consequences based on the analysis of preoperative and postoperative data on oesophageal manometry and a 24 h pH study in patients with morbid obesity.

The primary outcome variables analysed included pre- and post-LVSG LESP, LESL, and DMS, based on oesophageal manometry and 24 h pH study data. They also analysed pre-and post-LVSG BMI loss.

The meta-analysis included 19 studies (16 prospective and three retrospective), including 668 patients (445 females). Twelve studies undertook 24h pH studies to assess DMS. The postoperative follow-up period ranged from 6 weeks to 24 months. A significant reduction of 3.82 mm Hg in LESP was observed after LVSG compared to pre-LVSG patients based on 16 studies (WMD 3.82, 95% CI 1.74, 5.90; p<0.001). LESL did not reveal any significant difference between pre- and post-LVSG in nine studies.

The DeMeester Score (DMS) showed a significant increase in 11.72 post LVSG vs pre LVSG based on 12 studies (WMD –11.72, 95% CI –17.15 to –6.30; p<0.001). The BMI analysis revealed a significant reduction of 13.26 kg/m2 post-LVSG compared to pre-LVSG based on 12 studies (WMD 13.26, 95% CI 11.65 to 14.88, Z = 16.07, p<0.001).

“All these findings should raise alarm among surgical fraternities and clinical decision makers,” the authors cautioned. “It is hoped that appropriate patient selection prior to bariatric surgery using EFTs will advance our understanding of LES physiology and any associated PEMD in patients with morbid obesity, thereby preventing inappropriate bariatric procedures in the first place and optimising the choice of revisional bariatric procedures if necessary.”

The findings were reported in the aper, ‘Impact of laparoscopic vertical sleeve gastrectomy (LVSG) on lower esophageal sphincter pressure (LESP), lower esophageal sphincter length (LESL) and gastroesophageal reflux disease (GERD) using esophageal function tests (EFTs): a systematic review and meta-analysis’, published in the International Journal of Obesity. To access this paper, please click here