Perioperative Interventions to Prevent Gastroesophageal Reflux Disease and Marginal Ulcers After Bariatric Surgery - an International Experts' Survey

Objective This study aimed to survey international experts in metabolic and bariatric surgery (MBS) to improve and consolidate perioperative interventions to prevent gastroesophageal reflux disease (GERD) and marginal ulcers (MU) after MBS. Background Very important long-term complications after MBS include GERD, Barrett's esophagus, and MU. Prevention might be fundamental to reduce the incidence, severe complications, and the increasing number of revisional bariatric surgeries. Methods An international scientific team designed an online confidential questionnaire with 45 multiple-choice questions. The survey was sent to 110 invited experts and 96 of them (from 41 different countries) participated from 21 July 2022 to 4 September 2022. Results Most experts (& GE; 90%) prescribe postoperative acid suppression agents after MBS. Life-long proton pump inhibitors prophylaxis in smokers with avoidance of non-steroidal anti-inflammatory drugs are recommended by most of the experts (66%, 73%) after any type of gastric bypass. Two-thirds of experts (69%) perform Helicobacter pylori eradication prior to MBS. Two-thirds of experts (68%) routinely perform EGD and biopsy before MBS. Follow-up esophagogastroduodenoscopy (EGD) and timing threshold for revisional and conversional MBS were variable among experts. Conclusion This expert survey underlines important perioperative interventions that reached a two-thirds consensus among MBS international experts. Variability in follow-up EGD, approach to complication management, and thresholds for revisional and conversional MBS emphasize the need for further researches and consensus guidelines.

Automated summary

The objective of this study was to survey international experts in metabolic and bariatric surgery (MBS) to improve and consolidate perioperative interventions for preventing gastroesophageal reflux disease (GERD) and marginal ulcers (MU) after MBS. The results of the survey showed that most experts (>90%) prescribe postoperative acid suppression agents after MBS. Lifetime proton pump inhibitors prophylaxis and avoidance of non-steroidal anti-inflammatory drugs were recommended by the majority of experts (66%, 73%) after any type of gastric bypass. Two-thirds of experts (69%) perform Helicobacter pylori eradication prior to MBS, and EGD and biopsy are routinely performed before MBS by two-thirds of experts (68%). However, there was variability in follow-up EGD, approach to complication management, and thresholds for revisional and conversional MBS, highlighting the need for further research and consensus guidelines.