Evaluation of clinical score, esophageal manometry and pH monitoring before and after conversion from sleeve gastrectomy to Roux-en-Y gastric bypass for refractory gastroesophageal reflux disease

Introduction : Gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) responds well to medical treatment. However, in refractory cases, surgical conversion to Roux-en-Y gastric bypass (RYGB) is considered the best option. The objective of this study was to evaluate the outcomes of sleeve-to-bypass conversion in patients with refractory GERD. Method : Retrospective analysis of prospectively collected patients undergoing this conversion, in which the clinical score (GERDq), esophageal manometry and pH monitoring were evaluated before and after 9 months after surgery. Results : Eleven patients with a mean age of 44.1 years were included, 10 of whom were female, with a mean BMI of 32.3 kg/m2 and a mean postoperative time of 6.1 years after SG. After conversion, the mean total weight loss was 14.1% and the mean total GERDq score decreased from 35.4 to 8.3. There was no difference between the esophageal manometry results before and after surgery. There was a reduction in the mean DeMeester score at pH monitoring from 70 to 34, in the total number of distal reflux episodes from 43.8 to 19.1, and in the total number of proximal reflux episodes from 7.8 to 2.2. In esophageal manometry, the mean lower esophageal sphincter length before conversion was shorter in patients who maintained abnormal pH monitoring after surgery (2.3 vs. 4.4 cm). Conclusion : The conversion from SG to RYGB demonstrated clinical improvement in parameters related to GERD in most patients. Although pH monitoring changes persisted, there was an improvement in the DeMeester score. The lower esophageal sphincter length may be associated with persistent reflux after conversion.