Prevalence of Severe Erosive Esophagitis After Sleeve Gastrectomy: A Systematic Review and Meta-Analysis.

BACKGROUND: Obesity has been a notable health problem over the past few decades because of its association with variable associated medical problems. Although sleeve gastrectomy (SG) is an important bariatric procedure, some reports suggest that its anatomical changes may compromise anti-reflux mechanisms. This systematic review and meta-analysis aim to evaluate the prevalence of postoperative endoscopically confirmed severe erosive esophagitis (EE), specifically defined as Los Angeles Grade C or D. METHODS: This research involved systematic review and meta-analysis of observational studies, with the study procedure in line with PRISMA 2020 guidelines. Extensive research was done in PubMed/MEDLINE, Scopus, and Web of Science to find studies on adult patients undergoing primary SG, followed by postoperative endoscopic evaluation. To be considered eligible, the study had to explicitly report erosive esophagitis, Los Angeles Grade C and/or Grade D. RESULTS: Fifteen studies involving an overall counted patients of 1,587 patients were included in the meta-analysis, all of which were determined to be of high methodological quality. The overall pooled prevalence of severe erosive esophagitis (Los Angeles Grade C or D) was 3% (95% CI: 2%–6%), with substantial statistical heterogeneity (I² = 68.6%). prospective studies reported a prevalence of 7%, compared to 2% in retrospective studies. CONCLUSION: The overall prevalence of EE following SG is approximately 3%. While GERD remains a frequent post-procedure, the progression to endoscopic high-grade is a relatively infrequent phenomenon. However, the development of severe esophagitis represents a clinically significant outcome.