Meta-analysisindependent cross-checkabstract checked★ key study I-BAR-110 in-depth review
Meta-analysis: reflux 4+ years after sleeve
Meta-analysis of Long-term De Novo Acid Reflux-Related Outcomes Following Sleeve Gastrectomy: Evidence Against the Need for Routine Postoperative Endoscopic Surveillance.
Overview
Hajibandeh et al.. Curr Obes Rep 2023 · PMID 37535236 · DOI 10.1007/s13679-023-00521-4
About 1 in 4 developed new reflux and about 7 in 100 had Barrett changes; authors think the Barrett figure may be too high.
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?
Long-term reflux complications
- How was the study done?
Meta-analysis
- How many people, animals or samples were studied?
7,904 patients
- What was actually found?
GORD 24.8%, BE 6.7%
- How large was the observed effect?
Proportions
- What do the results mean in everyday life?
Most patients do not get new reflux
- What are the study's limitations?
Reporting bias
- What does it say about Elawady's specific claim?
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
- Hajibandeh et al.
- Journal
- Curr Obes Rep
- Year
- 2023
- Identifier
- PMID 37535236 DOI 10.1007/s13679-023-00521-4
- 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
What is the long-term risk of de novo GORD, oesophagitis and Barrett after sleeve gastrectomy, and is routine endoscopic surveillance needed?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and proportion meta-analysis of studies with >=4 y follow-up
- Population
Patients after primary SG followed >=4 y
- Country
Multinational
- Period
Median follow-up 60 months (48-132)
- Sample size
32 observational studies, 7,904 patients
- Inclusion and exclusion criteria
Primary SG, >=4 y follow-up
4. Methods and endpoints
- Exposure / intervention
Sleeve gastrectomy
- Comparator
None (proportions)
- Endpoints
De novo GORD, oesophagitis, Barrett oesophagus
- Statistical methods
Random-effects proportion meta-analysis
5. Actual results
- Results
Preoperative reflux symptoms 19.1%. De novo GORD 24.8% (18.6-31.0), oesophagitis 27.9% (17.7-38.1), Barrett 6.7% (3.7-9.7); significant heterogeneity. Many studies did not report BE/oesophagitis, which may inflate pooled estimates.
- Absolute risks
De novo GORD about 1 in 4; de novo Barrett about 7 in 100 (possibly overestimated).
- Authors' conclusion
Long-term de novo GORD after SG seems comparable with the general population; surveillance endoscopy recommended for symptomatic patients only.
6. Strengths
- Restricted to >=4 y follow-up
7. Weaknesses
- Observational only
- Reporting bias acknowledged by authors
- Comparison with general population not formally tested in the abstract
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
9. Assessment of the statistical interpretation
Proportions with wide CIs; I2 high.
10. Relevance to the specific claim
Shows that most sleeve patients do not develop de novo GORD; also gives a BE estimate the authors consider possibly inflated.
11. Independent contrary findings
Other meta-analyses favour surveillance.
12. Transferability to Germany and Europe
International.
13. Overall methodological judgement
Moderate evidence that reflux is common but not 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
Need for routine surveillance.
15. Linked fact checks
- 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 with mixed or unclear results