FELSENREICH Daniel Moritz

Weight Loss, Reflux and Reoperations: 10 Years of Laparoscopic Sleeve Gastrectomy - a Multicenter Reasearch

Background

With promising short time results, laparoscopic sleeve gastrectomy (SG) has become the second most performed bariatric procedure worldwide. Along with the Roux-en-Y gastric bypass (RYGB), SG is the most frequently performed bariatric procedure for obese patients and their comorbidities in Austria.
However, concerning long-term follow-up, the durability of weight loss success and the incidence of clinically relevant gastroesophageal reflux (GERD) are still matters of controversy. Surprisingly, apart from a growing number of studies covering up to five years of follow-up, only limited data has been published on long-term results following SG so far.

Method/Design

In a first step, all patients from three bariatric centres with a follow-up of 10 or more years after SG are going to be recruited. This process will include invitation letters and an informative conversation in our walk-in clinic.
We plan to analyse weight loss success, weight regain and the incidence of revision surgery, as well as our patients’ Quality of Life (QoL) and gastrointestinal QoL, which will be surveyed by standardized questionnaires for all patients, who have not been converted until today. Extensive blood panels will help to detect deficiencies of patients’ blood samples, especially in electrolyte, vitamin and hormone levels. 
Patients will also be tested for GERD, Barrett oesophagus and gastritis by gastroscopy, taking several biopsies of the duodenum, the different parts of the stomach and the oesophagus as well as of any suspicious areas. We will especially focus on detecting hiatal hernia, CLE areas at the gastro-oesophageal junction and bile in the stomach. Shape and size of the pouch will also be examined. The histological evaluation will then reveal active or chronic gastritis, infection with helicobacter pylori, and Barrett oesophagus with or without dysplasia of the Ora Serrata.
Manometry will measure the lower oesophageal sphincter’s pressure and ability to relax, as well as the bolus transit time of a liquid. In addition, the entire bolus transit function of liquids and the changes in pressure will be analysed.
24-hour-pH-metry will measure the number of refluxes and the acid exposure time of the oesophagus over 24 hours.
Data on long-term history of weight, surgical history, complications and their current medication will then be collected from all our patients, including those who have been converted within the follow-up period after the sleeve gastrectomy. In case of converted patients we will also take note of the reason for the conversion.
In a second step, we plan to repeat these examinations on an additional group of patients to complete a sample of 100, regardless of the exact follow-up time.  This group represents the first patients ever to have had LSG in either of the following bariatric centres:
• General Hospital AKH Vienna (Währingerstr.18-20; A-1090 Wien)
• Rudolfsstiftung Hospital (Juchg. 25; A-1030 Wien)
• Klosterneuburg Hospital (Kreuzerg. 12-14; A-3400 Klosterneuburg)

Formerly undetected diseases will be treated and taken care of in order to prevent an aggravation.

Aim

The aim of this study is to determine the long-term outcome of SG in terms of weight loss success, weight regain and reoperations in a series of 100 patients in Austria, in order to assess the long-term durability of this popular bariatric procedure.
Furthermore, the number of patients suffering from a symptomatic reflux as well as the effects on the oesophagus, the gastroesophageal junction and the stomach will be analysed. In this context, the focus will be on the appearance of Barrett oesophagus.

Methods and Skills:

Clinical studies; retrospective data analysis