Predictive value of preoperative DeMeester score on conversion to Roux-en-Y gastric by-pass for gastroeosophageal reflux disease after sleeve gastrectomy

Abstract Background Obesity is well-known to increase the risk of GastroEsophageal Reflux Disease (GERD). Impact of Sleeve Gastrectomy (SG) on GERD is still discussed but seems to be associated with the development of de novo GERD or the exacerbation of preexisting GERD. Objective The objective of this study was to evaluate the impact of preoperative pH monitoring, using the DeMeester score (DMS), on the risk of conversion to Roux-en-Y gastric by-pass (RYGB) after SG. Setting University Hospital in Nantes (France) Methods This monocentric study reported the results of a retrospective chart review of 523 obese individuals treated between 2011 and 2018. All patients underwent primary bariatric surgery. Ninety five percent of them had undergone a SG. GERD diagnosis was established with preoperative DMS based on 24-hour esophageal pH monitoring. Results Preoperative DMS was identified in 423 patients (86%). Sixty-seven patients (14%) underwent a second bariatric procedure; among them, 36 (54%) have been converted to RYGB because of GERD. There was no significant difference between preoperative DMS (16.1 +/- 22 vs 13.7 +/- 14, P=0.37) in patients undergoing conversion for GERD and the non-converted ones. The sensitivity, specificity, positive predictive and negative predictive values of the preoperative DMS for predicting conversion to RYGB were 25%, 66%, 7% and 4% respectively. In patients who underwent a conversion for GERD, DMS (P Conclusion Preoperative DMS alone is not predictive of the risk of conversion of SG to RYGB for GERD.