Evaluating the role of preoperative endoscopy in predicting GERD after sleeve gastrectomy: An ambidirectional observational study.

Abstract Introduction Sleeve gastrectomy (SG) has become a leading bariatric procedure, although gastroesophageal reflux disease (GERD) remains a frequent postoperative issue. This study determined whether preoperative endoscopic findings can help predict the risk of GERD after SG. Materials and Methods We performed an ambidirectional cohort study including 207 patients who underwent SG. The data collected included age, sex, BMI, comorbidities, preoperative GERD symptoms, and esophagogastroduodenoscopy (EGD) results (Hill grade and esophagitis). GERD symptoms were evaluated at 1 year using the GERD-HRQL questionnaire. Multivariable logistic regression identified factors associated with postoperative GERD, GERD resolution, and new-onset GERD. Results One year after SG, the prevalence of GERD increased from 45–60% (p = 0.003). Preoperative GERD symptoms (OR 3.83; 95% CI 1.87–7.87; p < 0.001) and lower preoperative BMI (OR 0.93; 95% CI 0.88–0.99; p = 0.027) were independently linked to postoperative GERD. Among patients with preoperative GERD, higher preoperative BMI was associated with symptom resolution (OR 1.11; 95% CI 1.03–1.21; p = 0.011). Older age was associated with a reduced risk of developing de novo GERD (OR 0.94; 95% CI 0.89–0.99; p = 0.013). Neither Hill classification nor esophagitis on EGD predicted GERD outcomes. Conclusions Preoperative GERD symptoms and BMI were the most reliable predictors of GERD after SG. Routine endoscopy provided no added value in predicting postoperative reflux, suggesting it may have limited utility for assessing postoperative GERD risk.