Meta-analysisindependent cross-checkabstract checked★ key study I-BAR-109 in-depth review
Meta-analysis: reflux after sleeve
Does Sleeve Gastrectomy Expose the Distal Esophagus to Severe Reflux?: A Systematic Review and Meta-analysis.
Overview
Yeung et al.. Ann Surg 2020 · PMID 30921053 · DOI 10.1097/SLA.0000000000003275
About 23 in 100 developed new reflux after sleeve, 28 in 100 had oesophagitis at long-term endoscopy, and 4 in 100 needed a second operation for reflux.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Estimate reflux after sleeve
- How was the study done?
Meta-analysis
- How many people, animals or samples were studied?
10,718 patients
- What was actually found?
De novo reflux 23%; oesophagitis 28%; Barrett 8%
- How large was the observed effect?
Proportions
- What do the results mean in everyday life?
Reflux is a frequent downside, not universal
- What are the study's limitations?
Heterogeneous, uncontrolled
- What does it say about Elawady's specific claim?
Supports "increases reflux"; contradicts "inevitable"
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Cancer risk
Scientific in-depth review
1. Full reference
- Authors
- Yeung et al.
- Journal
- Ann Surg
- Year
- 2020
- Identifier
- PMID 30921053 DOI 10.1097/SLA.0000000000003275
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref API
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract
2. Research question
How common are GERD, oesophagitis and Barrett oesophagus after sleeve gastrectomy?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis of proportions
- Population
Patients after primary sleeve gastrectomy
- Country
Multinational
- Period
not stated in abstract
- Sample size
46 studies, 10,718 patients
- Inclusion and exclusion criteria
Studies of postoperative outcomes after primary SG
4. Methods and endpoints
- Exposure / intervention
Sleeve gastrectomy
- Comparator
Preoperative status (where available)
- Endpoints
Increase in GERD, de novo reflux, oesophagitis, Barrett oesophagus, conversion for reflux
- Statistical methods
Pooled prevalence meta-analysis
5. Actual results
- Results
Increase of postoperative GERD 19%; de novo reflux 23%; long-term oesophagitis 28%; Barrett oesophagus 8%; 4% required conversion to RYGB for severe reflux. Symptoms did not always correlate with pathology.
- Absolute risks
De novo reflux about 23 in 100; conversion for reflux about 4 in 100.
- Authors' conclusion
Postoperative GERD, oesophagitis and Barrett after SG are significant; consent and surveillance should consider them.
6. Strengths
- Large number of studies
- Several reflux outcomes
7. Weaknesses
- Observational, heterogeneous
- Uncontrolled pre-post designs
- Selective endoscopy
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Overlaps with Chandan 2025 (I-BAR-04) and Hajibandeh 2023 (I-BAR-110); not independent confirmation.
9. Assessment of the statistical interpretation
Proportions, not comparative effect sizes; heterogeneity likely high.
10. Relevance to the specific claim
Confirms that sleeve-related reflux is real and common, and shows it is not universal (about 1 in 4 de novo).
11. Independent contrary findings
Prevalence not controlled against non-operated people with obesity.
12. Transferability to Germany and Europe
International including European cohorts.
13. Overall methodological judgement
Solid confirmation of frequent reflux after sleeve; contradicts "inevitable".
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Clinical consequences.
15. Linked fact checks
- Sleeve gastrectomy substantially increases gastro-oesophageal reflux disease and erosive oesophagitis. – Studies supporting the claim
- After sleeve gastrectomy reflux is inevitable, and patients must take acid-suppressing drugs for life. – Studies contradicting or limiting the claim
- Sleeve gastrectomy leaves the oesophagus exposed to Barrett's oesophagus (archive: Barrett's in 4% at 10 years in SLEEVEPASS). – Studies supporting the claim