Association Between Cholecystectomy and Gastroesophageal Inflammatory Findings After Sleeve Gastrectomy: Endoscopic and Metabolic Evaluation

Abstract

Sleeve gastrectomy (SG) is associated with the development or worsening of gastroesophageal reflux disease (GERD). Cholecystectomy following SG — the standard treatment for cholelithiasis resulting from rapid weight loss — may influence GERD pathophysiology by enhancing enterohepatic bile circulation and increasing alkaline reflux. To investigate the longitudinal development of endoscopic and histologic esophageal and gastric mucosal findings, alongside systemic metabolic profiles, across defined pre- and post-cholecystectomy intervals in individuals previously managed with SG. A longitudinal, retrospective, observational cohort study was conducted with 133 patients who underwent cholecystectomy after SG between 2009 and 2017. Endoscopic findings were analyzed at three time points: pre-SG, pre-cholecystectomy, and post-cholecystectomy. Compared with the pre-sleeve gastrectomy assessment, moderate esophagitis increased from 3.0% to 12.2% and severe esophagitis from 0.8% to 2.7% at the post-cholecystectomy evaluation. In contrast, the direct comparison between the pre- and post-cholecystectomy assessments demonstrated a significant increase in gastric inflammatory findings, particularly moderate gastritis. Gastritis prevalence increased from 33.9% to 51.4% (p < 0.05), with moderate to severe cases rising from 11.9% to 23.0% (p < 0.05). BMI and metabolic parameters (HbA1c, insulin, fasting glucose, cholesterol, triglycerides, uric acid, and C-peptide) improved significantly (p < 0.001). Cholecystectomy following sleeve gastrectomy was associated with an increased prevalence and severity of gastritis and a progressive trend in esophagitis over time, without compromising the long-term metabolic benefits of SG. Progressive upper gastrointestinal inflammatory changes were observed throughout follow-up after sleeve gastrectomy and cholecystectomy. Gastritis demonstrated the most consistent and statistically significant progression after cholecystectomy. Metabolic improvements achieved after sleeve gastrectomy were maintained after cholecystectomy. The observational design does not allow determination of whether these findings are attributable to cholecystectomy or the natural evolution of post-sleeve gastrectomy reflux disease.