15 Years after Sleeve Gastrectomy: Gastroscopies, Manometries and 24h pH-metries in a Long-term Follow-up – A Multicenter Study

INTRODUCTION: Sleeve Gastrectomy (SG) is the most common bariatric operation with over 340.000 procedures per year. There are only few studies presenting follow-up results >10 years in the literature today. The aim of this study was the objective evaluation of long-term outcomes of at least 15 years after SG in non-converted patients. METHODS: This study (multicenter cross-sectional; university-hospital based) includes all non-converted patients with primary SG before December 2005 at participating bariatric centers. The following methods were used: gastroscopy, esophageal manometry, 24h pH-metry, and Gastrointestinal Quality of Life Index (GIQLI). RESULTS: After removing converted patients, patients with bariatric procedures before SG, and deceased patients from the cohort, 20 of 53 participants have met the inclusion criteria. Of this group, 55% are suffering from symptomatic gastroesophageal reflux disease (GERD); 45% are without GERD. Esophagitis, hiatal hernias, Barrett´s esophagus, and enlarged sleeves were found in 44%, 50%, 13%, and 69% of patients during gastroscopy. Mean lower esophageal sphincter pressure was normal at 20.2 ±14.1mmHg during manometry. Reflux activity in 24h, number of refluxes, and DeMeester score were increased at 12.9 ±9.7%, 98.0 ±80.8, and 55.3 ±36.3 during 24h pH-metry. Patients with GERD scored significantly lower in the GIQLI than patients without GERD: 107.6 ±18.4 versus 127.6 ±14.4 (p=0.04). DISCUSSION / CONCLUSION: Fifteen years after primary SG, objective testing has shown that GERD, esophagitis, and Barrett´s esophagus are major issues for these patients. Surveillance endoscopies at five-year intervals in all SG patients and three-year intervals in patients with Barrett´s esophagus are recommended.