Impact of preoperative wireless pH monitoring in the evaluation of esophageal conditions prior to bariatric surgery in a severely obese patient population

Abstract

Background: Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure in the United States; however, it can be associated with development of de novo gastroesophageal reflux (GERD) or worsening of existing GERD. Preoperative esophagogastroduodenoscopy (EGD) and findings of esophagitis are commonly used as screening tool, but the alternative use of preoperative objective measurement of acid reflux has not been studied.

Objective: The aim of this study was to evaluate if preoperative objective measurement of acid reflux by using wireless pH monitoring (WPHM) could have an impact on surgical planning and outcomes.

Setting: Academic Center of Excellence.

Methods: Retrospective review of a prospectively collected database of 43 adult obese patients with reflux symptoms who underwent outpatient EGD and WPHM between September 2011 and September 2017.

Results: Change in planned surgical management from SG to Roux-en-Y-gastric bypass with the use of WPHM occurred in 21.0% (n = 9) of patients. Only 2.3% (n = 1) developed de novo GERD after SG. Nonerosive reflux disease was the most common esophageal condition on preoperative EGD. EGD, as a single diagnostic tool, appeared insufficient to diagnose acid reflux and help with the decision planning in this patient population.

Conclusions: Based on objective data obtained by measurement of GERD, using preoperative WPHM compared with preoperative EGD alone aids in a better patient selection for either SG or Roux-en-Y-gastric bypass. Our cohort with preoperative WPHM required no surgical conversions or revisions.

Keywords: Gastroesophageal reflux; Measurement; Patient selection; Preoperative esophagogastroduodenoscopy; Roux-en-Y-gastric bypass; Sleeve gastrectomy; Wireless pH monitoring.