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Gastroesophageal Reflux and Laparoscopic Sleeve Gastrectomy: Results of the First International Consensus Conference

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Abstract

Background

Gastroesophageal reflux disease (GERD) is probably the main drawback of laparoscopic sleeve gastrectomy (LSG). Herein, we critically discuss the issue and report the results of the first international consensus conference held in Montpellier, France, during June 2019.

Methods

Fifty international bariatric experts from 25 countries convened for 2 days for interactive discussions, and to formulate the most relevant questions by electronically submitting 55 preliminary questions to panelists. Following the meeting, a final drafted questionnaire comprised of 41 questions was sent to all experts via e-mail.

Results

Forty-six experts responded (92%). Esophago-gastro-duodenoscopy was considered mandatory before (92%) and after (78%) surgery. No consensus was achieved as to time intervals after surgery and the role of specialized tests for GERD. Higher degrees of erosive esophagitis (94%) and Barrett’s esophagus (96%) were viewed as contra-indications for LSG. Roux-en-Y gastric bypass was recommended in postoperative patients with uncontrolled GERD and insufficient (84%) or sufficient (76%) weight loss and Barrett’s esophagus (78%). Hiatal hernia (HH) repair was deemed necessary even in asymptomatic patients without GERD (80% for large and 67% for small HH). LSG with fundoplication in patients with GERD was considered by 77.3% of panelists.

Conclusions

The importance of pre- and postoperative endoscopy has been emphasized. The role of specialized tests for GERD and the exact surveillance programs need to be further defined. LSG is viewed as contra-indicated in higher degrees of endoscopic and clinical GERD. LSG with anti-reflux fundoplication emerges as a new valid option in patients with GERD.

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Authors and Affiliations

  1. Division of Advanced Laparoscopic and Bariatric Surgery, Department of General Surgery, Rambam Health Care Campus and the Technion Faculty of Medicine, 8 Haalia str, 3109601, Haifa, Israel

    Ahmad Assalia

  2. Hôpital du Sacre Coeur, Montreal, Canada

    Michel Gagner

  3. Herbert Wertheim School of Medicine, Miami, FL, USA

    Michel Gagner

  4. Centre de Chirurgie de l’Obesite (CCO), Clinique Bouchard, Marseille, France

    Marius Nedelcu

  5. Centre de Chirurgie de l’Obesite (CCO), Clinique Saint Michel, Toulon, France

    Marius Nedelcu

  6. Gastro-Obeso-Center Institute for Metabolic Optimization, Sao Paulo, Brazil

    Almino C. Ramos

  7. Bariatric Unit, CHU Montpellier, Institut de génomique fonctionnelle, CNRS, INSERM, University of Montpellier, Montpellier, France

    David Nocca

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Appendix 1: Agenda of consensus conference

Appendix 1: Agenda of consensus conference

1st International Consensus Conference on GERD & Bariatric surgery

Faculty of Medicine of Montpellier, France. June 28-29th, 2019

FRIDAY JUNE 28TH

08:30 AM WELCOME: D. NOCCA, M. GAGNER

GERD AND BARIATRIC SURGERY

09:00 AM GERD: DEFINITION AND DIAGNOSTIC TESTS- G. DEL GENIO

09:20 AM OBESITY AND GERD: LITÉRATURE REVIEW- T. ROGULA

09:40 AM GERD AND BARIATRIC SURGERY: A. ASSALIA

10:00 AM BARRETS OESOPHAGUS: DEFINITION, EVOLUTION &,

TREATMENT- F. CUENCA- ABENTE

10.20 AM BARRETS OESOPHAGUS AFTER SLEEVE GASTRECTOMY:

REASONS TO BE ALARMED- A. IANNELLI

10.40 AM BARRETS OESOPHAGUS AFTER SLEEVE GASTRECTOMY:

NO REASON TO BE ALARMED- M. GAGNER

11:00 AM COFFEE BREAK

11:30 AM GERD AFTER BARIATRIC SURGERY: MEDICAL

TREATMENT- S. MSIKA

11.50 AM GERD AFTER BARIATRIC SURGERY: ENDOSCOPIC

TREATMENT- N. GALVAO

12.10 PM GERD AFTER BARIATRIC SURGERY: SURGICAL

TREATMENT- M. ROSLIN

12:30 PM ROUND TABLE: WHICH OPERATION FOR TREATMENT OF GERD

AFTER SLEEVE- J. PUJOL, A. TORRES, M. GAGNER, A. RAMOS,

M. CHEVALLIER

Break

HOW TO PREVENT GERD AFTER BARIATRIC SURGERY:

02:00 PM NISSEN FUNDOPLICATION: STATE OF THE ART- S. SOMERS

02:15 PM NISSEN SLEEVE- D. NOCCA

02:30 PM NISSEN SLEEVE- S. OLMI

02:45 PM TOUPET SLEEVE- M. ADALA

03:00 PM NISSEN GBP- B. DILLEMANS

03:15 PM BANDED GBP- R. CAIAZZO

03:30 PM HIATOPLASTY AND SLEEVE- G. SILECCHIA

03:45 PM CARDIOPEXY WITH TERES LIGAMENTUM- C. COPAESCU

Break

04:30 PM DEBATE: WHICH OPERATION FOR WHICH PATIENT? BARIATRIC EXPERTS

HIATAL HERNIA: J. CHEVALLIER, M. LOUREIRO, P, SALMINEN,

N. KAWAHARA, M. NEDELCU, M. BLANCHET

OESOPHAGITIS STAGE 1: A. SIGURDSSON, N. DI LORENZO,

F. PATTOU, T. LAFFULARDE, A. CORTES

OESOPHAGITIS STAGE 2: A. NEIMARK, P. OMELANCZUK, P. VILLALONGA,

M. ANSELMINO, J. GREVE

OESOPHAGITIS STAGE 3: M. BUSING, J. GUGENHEIM, C. COPAESCU,

O. EMUNGANIA, V. VAGE, P. NOEL

BARRETT’S ESOPHAGUS: J. RAO, A. IANNELLI, M. GAGNER,

M. EL BANNA

06:00 PM JOHNSON&JOHNSON SYMPOSIUM: THE LINX

PROCEDURE- C. BOZA

SATURDAY JUNE 29TH

8:30–12:30 PM

CONSENSUS CONFERENCE GERD AND BARIATRIC SURGERY

MODERATORS: A. ASSALIA, M. NEDELCU

QUESTIONS TO EXPERTS: E-VOTING SYSTEM

QUESTIONS TO THE EXPERTS BY THE AUDIENCE

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Assalia, A., Gagner, M., Nedelcu, M. et al. Gastroesophageal Reflux and Laparoscopic Sleeve Gastrectomy: Results of the First International Consensus Conference. OBES SURG 30, 3695–3705 (2020). https://doi.org/10.1007/s11695-020-04749-0

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