Endoscopic and Symptomatic Outcomes of Vonoprazan for Erosive Esophagitis Following Laparoscopic Sleeve Gastrectomy: An Exploratory Prospective Study.

Background　Gastroesophageal reflux disease (GERD) commonly occurs or worsens after laparoscopic sleeve gastrectomy (LSG); however, evidence regarding optimal medical management remains limited. This prospective study evaluated the endoscopic and symptomatic outcomes of Vonoprazan (VPZ), a potassium-competitive acid blocker, in erosive esophagitis (EE) following LSG.Methods　Among 54 consecutive patients who underwent LSG, 19 who developed GERD symptoms within one year were included in the analysis. At symptom onset, esophagogastroduodenoscopy (EGD) was promptly performed to assess EE according to the Los Angeles (LA) classification, and the Frequency Scale for the Symptoms of GERD (FSSG) questionnaire was administered. All symptomatic patients were treated with VPZ (20 mg once daily for 4 weeks), after which EGD and FSSG assessments were repeated to evaluate therapeutic efficacy.Results　Of the 19 patients, 16 (84.2%) had EE (LA grades A/B/C: 4/7/5), and 3 had non-erosive reflux disease (NERD). Among the patients with EE, 11 had de novo cases, and no grade C esophagitis was present preoperatively. The median interval to symptom onset was 40 days (range, 2-196 days). After 4 weeks of VPZ, complete mucosal healing was confirmed in all patients with EE (100% healing rate). The median FSSG scores in the EE group significantly improved from 28 (14-45) to 7 (1-31) (p<0.001).Conclusion　Short-term improvements in the endoscopic findings and symptoms were observed after 4 weeks of VPZ treatment in patients with EE, which represented the majority of postoperative GERD cases in this cohort. Larger controlled studies are required to confirm these findings.