The Management of Intractable Gastroesophageal Reflux Following Sleeve Gastrectomy: A Narrative Review

Abstract

Purpose of ReviewLaparoscopic sleeve gastrectomy (LSG) is currently the most commonly performed bariatric surgery in the world and is widely considered safe and effective for weight loss in the obese population. However, intractable gastroesophageal reflux disease (GERD) following LSG poses a clinical challenge, with significant impact on quality of life and the potential for development of Barrett’s esophagus This review aims to provide clinicians with a systematic approach to investigating and managing patients with intractable GERD following LSG.Recent FindingsManagement of GERD following LSG requires thorough clinical, anatomical and functional assessment in order to accurately diagnose GERD. Management should then be tailored to the patient in an integrated approach, with medical, endoscopic and/or operative interventions. Medical therapy includes PPIs and lifestyle therapy and are well established for GERD in the post-LSG population but limited in efficacy for severe disease. Endoscopic treatments such as anti-reflux mucosectomy and endoscopic radiofrequency ablation are novel, and benefits are still unclear. Operative interventions include conversion to Roux-en-Y gastric bypass with or without hiatal hernia repair, one anastomosis gastric bypass, duodenal switch, hiatal hernia repair or insertion of a Linx ™ device. These options have predominantly been studied in weight-loss failure post-LSG, with emerging evidence now in the treatment of intractable GERD following LSG.SummaryA three-pronged assessment including clinical factors, anatomical evaluation and functional studies are required to accurately diagnose intractable GERD following LSG. Following this, individualised management with medical therapy, endoscopic and/or operative interventions should be considered with the patient within a multidisciplinary healthcare setting.