TPW 7.06 Burden of Severe Erosive Esophagitis Post Sleeve Gastrectomy: A Systematic Review and Meta-Analysis

Abstract

Obesity is a major global health problem and is strongly associated with several comorbidities, including gastrointestinal disorders such as gastroesophageal reflux disease (GERD). Sleeve gastrectomy (SG) is a commonly performed bariatric procedure with proven efficacy; however, postoperative anatomical changes may impair anti-reflux mechanisms, potentially worsening existing GERD or inducing new-onset reflux. This systematic review and meta-analysis aimed to determine the prevalence of severe postoperative erosive esophagitis (EE), defined as Los Angeles (LA) Grade C or D, following SG. A systematic review and meta-analysis of observational studies was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, and Web of Science were systematically searched for studies involving adult patients undergoing primary SG with postoperative endoscopic assessment. Eligible studies explicitly reported EE classified as LA Grade C and/or D. Methodological quality was evaluated using the Newcastle–Ottawa Scale. Random-effects models were used to estimate pooled prevalence and assess heterogeneity. Fifteen high-quality studies including 1,587 patients were analyzed. The pooled prevalence of severe EE after SG was 3% (95% CI: 2%–6%), with substantial heterogeneity (I² = 68.6%). Prospective studies reported a higher prevalence of 7%, whereas retrospective studies showed a prevalence of 2%. Severe erosive esophagitis occurs in a small but clinically relevant proportion of patients following sleeve gastrectomy. While GERD is common after SG, progression to high-grade endoscopic esophagitis is relatively uncommon. Prospective data suggest that the true incidence of severe EE may be higher than that reported in retrospective studies.