Electrical stimulation of the lower esophageal sphincter to address gastroesophageal reflux disease after sleeve gastrectomy

BORBELY YVES; ORTIZ CAMILO; BOUVY, NICOLE; RODRIGUEZ LEONARDO ANTONIO; SCHULZ HENNING; NIEPONICE, ALEJANDRO

SURGERY FOR OBESITY AND RELATED DISEASES

ELSEVIER SCIENCE INC

Lugar: Amsterdam; Año: 2019

1550-7289

BackgroundLaparoscopic sleeve gastrectomy (LSG) can result in de novo and worsen preexisting gastroesophageal reflux disease (GERD). Post-LSG patients with GERD refractory to proton pump inhibitors (PPI) usually undergo more invasive, anatomy-altering Roux-en-Y gastric bypass surgery. Lower esophageal sphincter (LES) electrical stimulation (ES) preserves the anatomy and has been shown to improve outcomes in GERD patients.ObjectiveTo evaluate the safety and efficacy of LES-ES in post-LSG patients with GERD not controlled with maximal PPI therapy.SettingProspective, international, multicenter registry.MethodsPatients with LSG-associated GERD partially responsive to PPI underwent LES-ES. GERD outcomes pre- and poststimulation were evaluated based on quality of life, esophageal acid exposure (after 6?12 mo), and PPI use.ResultsSeventeen patients (11 female, 65%), treated at 6 centers between May 2014 and October, 2016 with a median follow-up of 12 months (range 6?24), received LES-ES. Median age was 48.6 years (interquartile range, 40.5?56), median body mass index 31.7 kg/m2 (27.9?39.3). All patients were on at least daily PPI preoperatively; at last follow-up, 7 (41%) were completely off PPI, 5 (29%) took PPI on an intermittent basis, and 5 (29%) were on single-dose PPI. Median GERD?health-related quality of life scores improved from 34 (on-PPI, 25?41) at baseline to 9 (6?13) at last follow-up (off-PPI, P