THE VERTICAL SLEEVE GASTRECTOMY AND GASTROESOPHAGEAL REFLUX DISEASE OUTCOMES
*Daniel Leslie, *Eric Wise, *Adam Sheka, *Hisham Abdelwahab, *Ryan Irey, *Ashley Benner, Sayeed Ikramuddin
University of Minnesota, Minneapolis, MN
OBJECTIVE(S): Concerns for gastroesophageal reflux disease (GERD) potentiation limit greater adoption of vertical sleeve gastrectomy (VSG). We assess whether patients undergoing VSG have increased incidence of Barrett’s esophagus (BE), endoscopy, and pharmaceutical intervention in patients with and without GERD, compared to those undergoing Roux-en-Y gastric bypass (RYGB).
METHODS: In OptumLabs® Data Warehouse, VSG and RYGB patients with over 2 years enrollment were identified and matched by followup time. GERD (reflux esophagitis, acid reducing prescription medication [Rx] and/or diagnosis of BE), upper endoscopy (UE), and readmissions were evaluated beyond 90 days.
RESULTS: 8,362 patients undergoing VSG and RYGB patients were matched 1:1. Age, gender, GERD presence (76.29% vs. 77.21%; p=0.21), and comorbidities except type 2 diabetes were similar in both groups. Comparing VSG with RYGB in patients with no preoperative GERD, new GERD developed in 576 (6.89%) and 896 (10.72%; p<0.001) while BE developed in 44 (0.53%) and 80 (0.96%; p=0.004). Postoperative UE was performed on 1,805 and 2,464 (21.59% vs. 29.47%; p<0.001), and readmission was required for 261 and 517 (3.12% vs. 6.18%; p<0.001). For those with GERD history, BE developed in 36 (0.43%) and 62 (0.74%; p=0.01), and Rx discontinued in 355 (4.25%) and 321 patients (3.84%; p=0.916). Postoperative UE was performed on 1,369 (16.37%) and 1,851 (22.14%; p<0.001), and readmission was required for 1,818 (21.74%) and 2,481 (29.67%; p<0.001).
CONCLUSIONS: Compared to RYGB, VSG may have superior long-term GERD outcomes and lower readmissions. These data challenge the prevailing opinion that patients with GERD undergo RYGB instead of VSG.
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