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Page 6 of 17 Shaker et al. Mini-invasive Surg. 2025;9:27 https://dx.doi.org/10.20517/2574-1225.2024.105

[33]
LSG (OR = 12.2, 17.9), preoperative esophagitis ≥ Grade B (OR = 8.7, 7.6), and age (OR = 1.9, 2.0) .

In addition, a recent retrospective analysis of 159 patients who underwent LSG and 183 patients who
underwent LRYGB at a single institution, with 1-5 years of follow-up, showed that early complications (< 30
days) were more frequent with LRYGB than with LSG (10.4% vs. 3.8%). Surgical site infection was the most
common early complication in both groups, but occurred more frequently in the LRYGB group than in the
LSG group (6.6% vs. 1.9%, P < 0.035). On the other hand, late complications (> 30 days) were more common
overall in the LSG group than in the LRYGB group (31.4% vs. 10.4%), with GERD being the most frequent
[34]
late complication (30.8% vs. 7.7%, P < 0.001) .
A systematic review and meta-analysis of 22 studies involving 20,495 LSG patients reported a pooled GERD
prevalence of 35% (33% in observational studies and 58% in clinical trials). Although the included studies
were affected by heterogeneity, the overall findings suggested a “moderate to high risk of developing GERD
following LSG” . This review shows a lower estimate than a previously conducted meta-analysis of nine
[35]
studies, which found an OR of 3.61 for developing GERD following LSG, with 50% of participants
affected . The discrepancy is partly attributed to methodological differences between the studies.
[36]
Regardless, both meta-analyses indicate that more than one-third of patients develop GERD following
surgery, which is not a negligible number that should be clearly communicated to patients as a potential
outcome. Despite variation in reported rates of de novo or worsening GERD and heterogeneity of the
studies, the overall effect of LSG appears to be refluxogenic.

PREVALENCE AND RISK OF BE AFTER LSG
GERD and obesity are both considered risk factors for BE, the only recognized precursor to esophageal
[37]
[38]
adenocarcinoma. A systematic review and meta-analysis of 46 retrospective and cohort studies totaling
10,718 patients with 3-132 months of follow-up evaluated the primary outcomes of esophagitis and BE
prevalence after LSG. Secondary outcomes included changes in de novo reflux. The pooled prevalence of
increasing GERD after SG was 19%, including in subgroup analyses of studies reporting long-term
outcomes over 24 months. The pooled prevalence of new-onset GERD was 23%, and 20% in long-term
studies. Esophagitis occurred in 30% of patients in the pooled analysis and in 28% of long-term studies. The
prevalence of BE was 6% overall and 8% in long-term studies. Severe reflux accounted for conversion to
RYGB in 4% of patients, both in the overall pooled analysis and in the subgroup analysis of long-term
studies. Studies informing these results exhibited substantial heterogeneity .
[38]

[39]
A systematic review and meta-analysis of 10 studies , including 680 patients who underwent upper
endoscopy between 6 months and 10 years after SG, showed a pooled prevalence of de novo BE of 11.6%.
There was no significant association between the prevalence of BE and postoperative GERD symptoms.
Moreover, the risk of esophagitis increased by 13% per year following SG . The American Society for
[39]
Gastrointestinal Endoscopy recommends that populations with a 10% risk of BE should undergo
[40]
screening . While this study indicates a risk of de novo BE following SG, several questions remain
unanswered, including whether this risk is outweighed by the metabolic benefits of weight loss, making the
role of routine screening and surveillance for BE in post-SG patients unclear .
[41]

A retrospective cohort study of a prospectively maintained database of 126 SG patients reported that 29.5%
of patients had reflux esophagitis at 5-year follow-up (Grade A, 15.2%; Grade B, 11.4%; Grade C, 11.4%; and
Grade D, 2.9%). BE was identified in 5.7% of patients at the 5-year mark after SG. The authors suggested
long-term BE surveillance in SG patients, regardless of reflux symptoms . Current expert opinion
[42]
recommends offering BE screening three or more years after LSG .
[43]