Assessment of Gastroesophageal Junction and Pyloric Distensibility Pre- and Post-Sleeve Gastrectomy
Overview
This pilot study evaluated changes in gastroesophageal junction (GEJ) and pyloric distensibility indices (DI) before and one year after sleeve gastrectomy (SG) using EndoFlip™. Results demonstrated a significant increase in DI of both the GEJ and pylorus postoperatively, with preoperative GEJ distensibility associated with postoperative gastroesophageal reflux disease (GERD).
Background
Sleeve gastrectomy is a common bariatric procedure but is frequently complicated by de novo or worsening GERD, which adversely affects quality of life. The GEJ plays a critical role in GERD pathophysiology, yet functional assessment tools in bariatric patients remain limited. EndoFlip™, an endoscopic functional luminal imaging probe, offers a novel method to measure distensibility of the GEJ and pylorus, potentially elucidating mechanisms underlying GERD development after SG.
Data Highlights
Parameter
Pre-SG Median DI (mm2/mmHg)
Post-SG Median DI (mm2/mmHg)
p Value
GEJ (40 ml)
1.4 [1.1–2.6]
2.9 [2.6–5.3]
0.046
Pylorus (40 ml)
6.0 [4.1–10.7]
13.1 [7.6–19.2]
0.046
Preoperative GEJ DI in pGERD vs npGERD
2.6 [1.9–3.5] vs 0.5 [0.5–1.1]
—
0.031
Key Findings
EndoFlip™ measurements showed a significant increase in GEJ distensibility index from pre- to 1 year post-SG (p=0.046).
Pyloric distensibility index also significantly increased post-SG (p=0.046), suggesting altered pyloric function.
Preoperative GEJ distensibility was significantly higher in patients who developed or had stable GERD postoperatively compared to those without GERD (p=0.031).
No significant differences in pyloric distensibility were observed between GERD and non-GERD groups preoperatively or postoperatively.
Weight loss parameters (%EWL, %TWL, %EBMIL, delta BMI) did not differ significantly between GERD and non-GERD groups at 1 year.
Postoperative GEJ and pyloric distensibility did not significantly differ between GERD and non-GERD groups.
Clinical Implications
EndoFlip™ may serve as a valuable tool for preoperative assessment of GEJ distensibility to predict the risk of GERD development after sleeve gastrectomy. Increased preoperative GEJ distensibility could identify patients at higher risk for postoperative reflux, guiding surgical planning and postoperative management. Additionally, the observed increase in pyloric distensibility post-SG may influence gastric emptying dynamics and warrants further investigation.
Conclusion
This pilot study demonstrates that sleeve gastrectomy significantly increases GEJ and pyloric distensibility indices, with preoperative GEJ distensibility associated with postoperative GERD. EndoFlip™ shows promise for functional assessment in bariatric surgery, but larger studies are needed to validate these findings and establish normative values.
References
Lyon Consensus 2018 -- Diagnosis of GERD
ASMBS Guidelines -- Bariatric Outcomes Reporting
Reynolds et al. / Greenberg et al. -- Intraoperative EndoFlip™ Assessment
