Gastroesophageal Reflux Disease After Sleeve Gastrectomy versus Roux-en-Y Gastric Bypass: An 8-Year Prospective Cohort Study.

Abstract

The long-term impact of bariatric procedures on gastroesophageal reflux disease (GERD) remains insufficiently characterized. Sleeve gastrectomy (LSG) is technically simpler but may predispose patients to reflux, whereas Roux-en-Y gastric bypass (LRYGB) is recognized for its durable anti-reflux effect. Robust prospective data comparing the procedures beyond 5 years are scarce. This study compared 8-year persistent or new-onset GERD after LSG versus LRYGB using multimodal assessment based on Lyon Consensus 2.0 criteria. In this prospective dual-cohort extension of a previous trial (n = 75), 51 patients (LSG = 19; LRYGB = 32) completed 8-year follow-up. Multimodal assessment included a symptom questionnaire, upper endoscopy, contrast radiology, manometry, and 24-h pH monitoring. The primary endpoint was conclusive GERD per Lyon 2.0 classification. Conclusive GERD was present in 94.7% of LSG patients compared with 25.0% following LRYGB (RR = 3.8; 95% CI, 2.06-6.97). Erosive esophagitis (Los Angeles grade ≥ B) was more frequent after LSG (73.7% vs. 18.8%; p < 0.001). Mean acid exposure time was higher after LSG (11.4 ± 6.0% vs. 2.7 ± 5.5%; p < 0.001). Pathological DeMeester scores (> 14.7) occurred in 66.7% of LSG patients versus 19.0% after LRYGB (RR = 3.44; p = 0.002). GERD-related complications, including Barrett's esophagus and conversion to LRYGB, were observed only after LSG. At 8-year follow-up, LSG is strongly associated with persistent or de novo GERD, whereas LRYGB maintains a durable protective effect. These findings highlight the relevance of appropriate preoperative evaluation and long-term reflux surveillance when selecting bariatric procedures. ClinicalTrials.gov Identifier: NCT03692455.