OA08.3. Upper Gastrointestinal Surgeon Perspective: Sleeve-Based Versus Roux-en-Y Bariatric Metabolic Surgery Affects De Novo and Improved EE, Hiatal Hernia, Barrett’s Esophagus

Abstract

Benign Disease: Gastro-Esophageal Reflux and Hiatal Hernia Bariatric surgery can alter reflux-related and premalignant esophageal conditions, yet the endoscopic trajectories of erosive esophagitis (EE), hiatal hernia (HH), and Barrett’s esophagus (BE)—and the impact of procedure type and cruroplasty as hiatal hernia repair (HHR)—remain incompletely defined. We evaluated incidence, improvement, and predictors of de novo and preoperative EE, HH, and BE one year after metabolic bariatric surgery. We retrospectively reviewed 277 patients who underwent sleeve gastrectomy (SG) (n=123), sleeve gastrectomy with proximal jejunal bypass (PJB-SG) (n=113), or laparoscopic Roux-en-Y gastric bypass (RYGB) (n=41). Preoperative and 1-year postoperative endoscopic findings were compared. Multivariable logistic regression assessed predictors of new-onset and improved EE, HH, and BE, adjusting for age, sex, surgical procedure, baseline endoscopic diagnoses, and HHR. De novo endoscopic lesions occurred in 62 patients (49 SG-based; 13 RYGB). Older age independently predicted de novo EE (OR 1.046, p=0.013), while RYGB was protective (OR 0.303, p=0.010). For postoperative HH, absence of HHR was associated with increased risk (OR 0.508, p=0.026). De novo BE was associated with concomitant HHR (OR 2.987, p=0.027). Among 215 patients with preoperative disease, RYGB was associated with improvement of EE (OR 0.304, p=0.046). HHR reduced HH recurrence (OR 0.487, p=0.032) but was associated with higher postoperative BE risk (OR 3.735, p=0.015). Upper gastrointestinal endoscopic outcomes after metabolic bariatric surgery vary by procedure and HHR. SG-based procedures showed higher susceptibility to de novo EE and BE, whereas RYGB was protective and favored improvement of preoperative EE. HHR decreased HH recurrence but was associated with increased BE risk, underscoring the need for individualized procedure selection and structured post-operative endoscopic surveillance.