High-resolution Impedance Manometry and 24h MII-pH before and after Sleeve Gastrectomy: De Novo Reflux in a Prospective Series

ABSTRACT Background Laparoscopic sleeve gastrectomy (SG)1 is increasingly popular but concerns its effect on gastro-esophageal reflux disease (GERD) remain. Current literature is conflicting and there has been little objective data. Objectives To objectively and more accurately assess the impact of SG on esophago-gastric physiology. Setting Centre of Excellence in Metabolic & Bariatric Surgery – Private Hospital, Australia Methods Prospective cohort study of 31 patients undergoing SG with high resolution impedance manometry (HRM), 24-hour multichannel intraluminal impedance combined with pH testing (MII-pH) and Gastroesophageal Reflux Disease Symptom Assessment Scale (GSAS) questionnaire 1 month prior to and 6 months after SG. Results 31 patients underwent SG, 20 with synchronous hiatal repair and fixation, 6 were excluded. HRM demonstrated significantly increased intra-gastric pressures (15.5 to 29.6 mmHg), failed swallows (3.1 to 7.5%) but no other change in esophageal motility. MII-pH did not demonstrate significant change in acid exposure time (8.5 to 7.5%) or number of reflux episodes although long reflux episodes (2.3 to 4.7) and weak acid reflux episodes were significantly increased (15.4 to 55.2). DeMeester and GSAS scores were not significantly changed. There was no significant difference in patients with pre-existing reflux. However, for patients without pre-existing reflux, acid exposure time (AET) increased significantly (1.3 to 6.7%), as did DeMeester scores (5.8 to 24.5), long reflux episodes (0.1 to 4.4) and weakly acidic episodes (22.1 to 89.2). Conclusion SG was associated with increased intra-gastric pressures, without changes in esophageal motility or acid exposure. For patients without pre-existing reflux there was an increase in acid exposure time, long reflux episodes, weakly acidic reflux episodes and DeMeester score.