Objective:

To assess the changes in gastroesophageal junction (GEJ) and pylorus distensibility before and after sleeve gastrectomy (SG) using EndoFlip™ and to explore its association with postoperative gastroesophageal reflux disease (GERD), which is a significant concern in SG outcomes.

Key Findings:

• Post-surgery, the distensibility index (DI) of the GEJ significantly increased from 1.4 mm²/mmHg to 2.9 mm²/mmHg (p=0.046), indicating improved distensibility.
• The pylorus DI also significantly increased from 6.0 mm²/mmHg to 13.1 mm²/mmHg (p=0.046), suggesting enhanced function.
• Preoperative DI of the GEJ was significantly different between patients who developed GERD postoperatively and those who did not (2.6 mm²/mmHg vs. 0.5 mm²/mmHg, p=0.031), highlighting its predictive value.

Interpretation:

The study suggests that increased preoperative GEJ distensibility is associated with the development of GERD one year after SG, indicating the potential of EndoFlip™ in predicting postoperative outcomes and improving patient management.

Limitations:

• The study had a small sample size, limiting the power for in-depth analysis and increasing the risk of type II errors.
• Findings need to be validated in larger cohorts to confirm the predictive value of EndoFlip™ for GERD after SG and to account for potential confounding factors.

Conclusion:

EndoFlip™ shows promise in assessing GEJ and pylorus distensibility and may help predict GERD outcomes after SG, but further research is needed to establish normative values and validate findings in larger, more diverse populations.