Abstract
PURPOSE: Single Anastomosis Sleeve Ileal (SASI) bypass effectively alleviates GERD symptoms but may increase bile reflux risk. This study evaluates the effects of SASI bypass impact on endoscopic GERD features and GERD-related quality of life. METHODS: This single-center study is a retrospective analysis of prospectively collected data from patients who underwent SASI bypass between March 2020 and August 2022. RESULTS: Esophagitis prevalence significantly decreased from 51.4% preoperatively to 20.0% after SASI bypass, p = 0.010. Notably, esophagitis grade B, present in 17.1% of patients before surgery, was utterly absent postoperatively, p = 0.041. Bile reflux significantly increased from 11.4% preoperatively to 62.9% postoperatively, p < 0.001, with de novo bile reflux occurring in 20 cases. Proton pump inhibitor use increased from 31.4% before surgery to 45.7% after, p = 0.302. An analysis of factors affecting the postoperative quality of life, assessed by the GERD-HRQL General Scale, identified preoperative PPI use as a significant predictor, with users being significantly less likely to achieve a higher postoperative quality of life (OR = 0.07, 95% CI [0.01–0.44]), p = 0.009. Preoperative bile reflux was associated with a 95% lower likelihood of improved postoperative quality of life (OR = 0.05, 95% CI [0.00–0.67]), p = 0.038. CONCLUSION: SASI bypass may be considered a suitable option for selected patients with mild GERD. Although endoscopic bile reflux increased postoperatively, most patients reported minimal reflux symptoms. Preoperative PPI use and bile reflux were associated with reduced postoperative quality of life, emphasizing the importance of appropriate patient selection and close follow-up.