P1337 - The Impact of Vertical-Banded Gastroplasty and Subsequent Revision on the Development and Severity of GERD

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Samantha Magier, MD, MS

Yale New Haven Hospital
New Haven, CT, United States

Samantha Magier, MD, MS¹, Dariush Jahandideh, MD², Andrew Duffy, MD¹, Mayra Sanchez, MD³, Amir Masoud, MD⁴
¹Yale New Haven Hospital, New Haven, CT; ²Griffin Hospital, New Haven, CT; ³Connecticut GI, PC, Fairfield, CT; ⁴Connecticut GI, Madison, CT

Introduction: Vertical-banded gastroplasty (VBG) is a form of bariatric surgery intended to treat morbid obesity. This technique was highly prevalent until long-term complications and more effective procedures were identified. Among the adverse effects were reports of weight regain, gastroesophageal reflux disease (GERD), esophagitis, and an increasing need for revision surgery. Despite these data, VBG is still widely endorsed as a viable option for weight loss surgery. This study was aimed at addressing the gap in literature regarding the effect of VBG and subsequent revision surgery on the rate and severity of GERD.

Methods: Retrospective chart review was performed on patients who underwent VBG from 2006 to 2012 and required revision with either band removal or conversion surgery to Roux-en-Y Gastric Bypass (RYGB) at a large academic center. All patients underwent esophagogastroduodenoscopy (EGD) prior to revision. Available esophageal manometry, pH monitoring, and impedance planimetry were reviewed. GERD severity pre- and post-revision was standardized as number of days per week patient reported symptoms. Initiation of medical therapy with proton pump inhibitors, H2 receptor antagonists, and antacids was evaluated.

Results: While 43% of patients reported GERD symptoms prior to VBG, 100% developed GERD post-operatively (n=23). Symptom severity significantly increased after VBG (p < 0.0001), requiring initiation of medical therapy in over 50% of patients. Revision led to a decrease in symptom severity (p=0.0041) and need for medical therapy (p < 0.0001). The band removal group (n=11) had more severe symptoms than the conversion group (n=12) (p=0.0437). The average weight of the band removal group was 111.4 kg versus 91.6 kg in the conversion group (p=0.0246). [Table 1]

Discussion: The prevalence of GERD and need for medical therapy was significantly increased in patients who underwent VBG and those who had subsequent band removal without conversion to RYGB. GERD severity and weight significantly decreased after conversion compared to band removal alone. Many patients without suggestive endoscopic findings or GERD symptoms prior to VBG developed GERD post-operatively, suggesting a strong anatomical pathophysiology. These data suggest that patients with a high risk of developing GERD or pre-existing symptoms should not be considered for this technique. Conversion to RYGB appears superior to band removal alone when assessing the prevalence of GERD and durability of subsequent weight loss.

	*Band Removal*	*Conversion Surgery*	*P-Value*

*Pre-VBG*
Age	57.5 ± 8.6	50.2 ± 11.9	0.1087
Gender (Female%)	55%	92%	0.0686
Non-Smoker (%)	33%	66%	0.2203
Weight on presentation	136.8 ± 23.9	132.3 ± 34.7	0.7263
BMI on presentation	46.9 ± 5.5	48.9 ± 9.2	0.5326
EBW (kg)	63.9 ± 19	65.1 ± 30.4	0.9118
Diabetes Mellitus (%)	18%	17%	1.000
Hypertension (%)	45%%	42%	1.000
GERD before VBG	55%	33%	0.4136
GERD severity before VBG (days/week)	1 ± 1.1	0.6 ± 1	0.3502
GERD treatment before VBG	50%	25%	0.2138

*Post-VBG*
Lowest weight after VBG	103.3 ± 20.9	92.2 ± 20.2	0.2089
Lowest BMI after VBG	35.4 ± 5.6	34.3 ± 6.2	0.6465
Weight difference before and after VBG	-33.5 ± 22.5 (loss)	40.1 ± 30.2 (loss)	0.5574
BMI difference before and after VBG	11.5 ± 7.3	14.6 ± 9.6	0.3854
Weight difference before revision surgery and after VBG	12 ± 23.7 (gain)	18.7 ± 16.3 (gain)	0.4366
GERD after VBG	100%	100%	1.000
GERD severity after VBG	6.2 ± 1	6.1 ± 1.2	0.6936
GERD treatment after VBG	82%	92%	0.5901
Response to GERD treatment (some relief)	100%	91%	1.000

*Post-Revision Surgery*
Weight after revision	111.4 ± 5.9	91.6 ± 5.7	0.0246
Weight difference before and after revision	2.8 ± 2.7 (gain)	18.2 ± 2.6 (loss)	< 0.0001
Weight difference after revision and on presentation	25.3 ± 15.3 (loss)	40.7 ± 24.3 (loss)	0.0873
BMI after revision	38.2 ± 5.8	34 ± 4.4	0.0658
BMI difference before and after revision	0.7 ± 1.9 (gain)	6.9 ± 4.6 (loss)	< 0.0001
BMI difference after revision and on presentation	8.6 ± 5.2 (loss)	14.8 ± 7.3 (loss)	0.0305
EBW after revision	38.6 ± 19.5	24.4 ± 12.5	0.0485
EWL % after revision	62 ± 13	39 ± 25	0.0101
GERD after revision surgery	50%	33%	0.4136
GERD severity after revision surgery	1.4 ± 0.3	0.4 ± 0.7	0.0437
GERD treatment after revision surgery	73%	50%	0.4003

Table: Table 1: Comparison of VBG Band Removal Alone vs. Conversion Surgery Groups Pre-VBG, Post- VBG, and Post-Revision Surgery.
BMI= Body Mass Index,
EBW= Estimated Body Weight,
EWL= Estimated Weight Loss

Disclosures:

Samantha Magier indicated no relevant financial relationships.

Dariush Jahandideh indicated no relevant financial relationships.

Andrew Duffy indicated no relevant financial relationships.

Mayra Sanchez indicated no relevant financial relationships.

Amir Masoud indicated no relevant financial relationships.

Samantha Magier, MD, MS¹, Dariush Jahandideh, MD², Andrew Duffy, MD¹, Mayra Sanchez, MD³, Amir Masoud, MD⁴. P1337 - The Impact of Vertical-Banded Gastroplasty and Subsequent Revision on the Development and Severity of GERD, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.