Table.
Summary of Bariatric Procedures Available to Patients, Their Mechanism of Weight Loss, and Effects on Reflux
| Bariatric procedures and effect on reflux | |||
|---|---|---|---|
| Procedure name | Mechanism of weight loss | Effect on reflux | Physiology of reflux effect |
| Endoscopic | |||
| Intragastric balloon (Orbera and ReShape) | Restrictive39,40 | Worsens: de novo GERD reported in 6.8% of patients following balloon placement.41 | Increases the intragastric pressure and gradient across the LES |
| Aspiration therapy (AspireAssist) | Removal of calories prior to absorption –malabsorptive | Unclear: 6.3% of patient reported reflux, however unclear if de novo.43 | Unknown |
| Endoluminal vertical gastroplasty | Restrictive | Likely improves: TRIM trial showed improvement in patients with baseline GERD.47 | Unclear: likely related to weight loss and decreased intra-abdominal pressure. |
| Endoscopic intestinal bypass (EndoBarrier and valenTx) | Malabsorptive | Unknown: ENDO trial in US stopped early due to development of liver abscesses.50 | Unknown |
| Duodenal mucosal resurfacing (Fractyl) | Unknown | Unknown | Unknown |
| Surgical | |||
| Laparoscopic sleeve gastrectomy | Restrictive | Conflicting studies: likely worsens reflux.55-63 SM-BOSS trial with 5-year follow-up showed worsening reflux.61 | Division of diaphragmatic crural ligaments and disruption of angle of His resulting in lower LES pressures. Decreased gastric pouch compliance causing increased intragastric pressure.66 |
| Roux-en-Y gastric bypass | Malabsorptive and restrictive | Improves: 94.0% of patients reported improved GERD symptoms and medication usage decreased significantly.76 | Weight loss results in decreased intra-abdominal pressure.77 Small gastric pouch limits acid production and reservoir available for regurgitation.79 Reduced duodenal gastric reflux by eliminating direct communication with esophagus.80 |
| Adjustable gastric band | Restrictive | Conflicting studies: shorter follow-up times reported improvement in reflux symptoms, while longer follow-up times showed development of de novo GERD.83-86 | Mechanisms for reflux improvement include weight loss leading to decreased intra-abdominal pressure, decreased frequency of LES relaxation, and reinforcement of the GE sphincter.87 |
GERD, gastroesophageal reflux disease; LES, lower esophageal sphincter; TRIM, Transoral Gastric Volume Reduction as Intervention for Weight Management; SM-BOSS, Swiss Multicenter Bypass or Sleeve Study.