Abstract
BACKGROUND: Obesity is a significant global health concern, with laparoscopic sleeve gastrectomy (LSG) being the most commonly performed bariatric surgery in the Middle East, including Saudi Arabia, due to its simplicity and effectiveness in achieving weight loss. However, the long-term effects of LSG on gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE) remain areas of active investigation. AIM: To determine the prevalence of GERD and BE 5 years post-LSG in a Saudi Arabian population. METHODS: A retrospective cohort study was conducted at a tertiary bariatric referral center in Saudi Arabia. Patients who underwent LSG 5 years prior and completed postoperative gastroscopy were included. Data on demographics, comorbidities, GERD symptoms, and endoscopic findings were extracted. GERD was defined clinically, esophagitis was graded per the Los Angeles classification, and BE was defined histologically. Multivariate logistic regression was used to identify predictors of GERD, endoscopic esophagitis (EE), and BE. RESULTS: The study included 114 patients (mean age: 44 years; 61% female). GERD prevalence increased from 16% preoperatively to 64% 5 years post-LSG, with 54% of cases representing de novo GERD. EE prevalence rose to 30%, with 23% of cases being de novo. BE was detected in 2.6% of patients, all presenting with short-segment BE without intestinal metaplasia. On univariate analysis, the pre-LSG body mass index was significantly associated with EE (P = 0.038), and age was significantly associated with BE (P = 0.037). However, on multivariate analysis, only hypertension was independently associated with GERD development (odds ratio = 5.09; P = 0.01). No factors were significantly associated with EE or BE on multivariate analysis. CONCLUSION: This study highlights the significant increase in GERD and EE prevalence 5 years post-LSG, with a relatively low but notable incidence of BE. The findings underscore the need for long-term endoscopic surveillance, particularly for older patients, even in populations with lower baseline.