Preoperative Factors Including Endoscopic Findings in Predicting Gastroesophageal Reflux Disease (GERD) After Sleeve Gastrectomy: An Observational Cohort Study

Background: Gastroesophageal reflux disease remains a common postoperative issue after sleeve gastrectomy. This study examined whether preoperative symptoms, clinical factors, and endoscopic findings predict reflux symptoms one year after surgery. Methods: We performed an observational cohort study including 207 patients who underwent sleeve gastrectomy (SG). Preoperative variables included age, sex, BMI, comorbidities, preexisting GERD symptoms, and esophagogastroduodenoscopy (EGD) results. GERD symptoms were evaluated at 1 year. Multivariable logistic regression identified factors associated with GERD after surgery, GERD resolution, and de novo GERD. Results: One year after SG, the prevalence of GERD increased from 45% to 60% (p = 0.003). Preexisting GERD symptoms (OR 2.54 (95% CI 1.39–4.63, p = 0.002) and lower preoperative BMI (OR 0.93; 95% CI 0.88–0.99; p = 0.027) were independently linked to GERD after surgery. Among patients with preoperative GERD, higher preoperative BMI was associated with symptom resolution (OR 1.11; 95% CI 1.03–1.21; p = 0.011). Neither Hill classification nor mild-to-moderate (Los Angeles grade A/B) esophagitis on EGD predicted GERD outcomes. Conclusions: Preexisting GERD symptoms and BMI were the most reliable predictors of GERD after surgery. Preoperative Hill classification and esophagitis showed no significant association in this cohort.