Fluoroscopic examination of stomach shapes after sleeve gastrectomy: Implications for long-term weight loss and esophagitis

Abstract Introduction: Stomach morphology influences laparoscopic sleeve gastrectomy (LSG) outcomes, including weight loss and gastroesophageal reflux. This study examined the impact of stomach shape on long-term weight loss and esophagitis post-LSG. Methods: We analyzed 162 patients who underwent LSG. Stomach shape was categorized into three subgroups based on postoperative fluoroscopy contrast pooling: upper and lower portions (ULP), lower portion (LP), and smooth flow (SF) postoperatively. Short-term operative outcomes, surgical procedures, five-year weight loss, and esophagitis, diagnosed by upper endoscopy using the L A classifications, were compared across groups. Results: The stomach shape distribution was ULP (12%), LP (29%), and SF (59%)). Operative outcomes were generally comparable; however, ULP tended to exhibit smaller bougie sizes (ULP: 31.8±9.7 vs. LP: 34.3±6.4 vs. SF: 34.4±6.3 cm). Preoperative assessments revealed no Grade C esophagitis, with most patients exhibiting normal findings. Post-LSG clinical changes were comparable, although de novo esophagitis was more frequent in the SF shape (ULP vs. LP vs. SF, de novo/improved/persistent/worsened, 10%/ 0% 84%/ 6% vs. 21%/ 0% 72% 6% vs. 31%/ 4%/ 60%/4%, respectively; p=0.24). Weight loss after LSG was compared, and no significant differences were observed among the groups; however, LP tended to maintain total weight loss (TWL) at 5 years (TWL%: ULP vs. LP vs. SF; 21.3±3.9 vs. 23.1±7.4 vs. 21.5 ±8.8 %, respectively; p=0.859). Conclusion: Patients with SF had the highest de novo esophagitis incidence. The LP shape was linked with sustained long-term weight loss. Therefore, creating an LP shape should be the optimal surgical objective.