Meta-analysisindependent cross-checkabstract checked I-BAR-111 standard review
How often severe gullet inflammation follows sleeve
Prevalence of Severe Erosive Esophagitis After Sleeve Gastrectomy: A Systematic Review and Meta-Analysis.
Overview
Alqasem et al.. Obes Surg 2026 · PMID 41964778 · DOI 10.1007/s11695-026-08605-5
About 3 in 100 sleeve patients had severe inflammation of the gullet at endoscopy.
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?
Severe oesophagitis after SG
- How was the study done?
Meta-analysis
- How many people, animals or samples were studied?
1,587
- What was actually found?
3% (7% in prospective studies)
- How large was the observed effect?
Proportion
- What do the results mean in everyday life?
Severe damage is uncommon
- What are the study's limitations?
Small, observational
- What does it say about Elawady's specific claim?
Limits "inevitable" framing
- 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
- Alqasem et al.
- Journal
- Obes Surg
- Year
- 2026
- Identifier
- PMID 41964778 DOI 10.1007/s11695-026-08605-5
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref API
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
COI statement (PubMed record): Declarations. Competing interests: The authors declare no competing interests.
2. Research question
How common is severe erosive oesophagitis (LA grade C/D) after sleeve gastrectomy?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis of observational studies
- Population
Adults after primary SG with postoperative endoscopy
- Country
Multinational
- Period
not stated in abstract
- Sample size
15 studies, 1,587 patients
- Inclusion and exclusion criteria
Studies explicitly reporting LA grade C and/or D
4. Methods and endpoints
- Exposure / intervention
Sleeve gastrectomy
- Comparator
None
- Endpoints
Severe erosive oesophagitis
- Statistical methods
Random-effects proportion meta-analysis
5. Actual results
- Results
Pooled severe EE 3% (2%-6%), I2 68.6%; prospective studies 7% vs retrospective 2%.
- Absolute risks
Severe oesophagitis about 3 in 100.
- Authors' conclusion
GERD remains frequent after SG, but progression to high-grade oesophagitis is relatively infrequent, though clinically significant.
6. Strengths
- Clear endoscopic definition
7. Weaknesses
- Small total sample
- Observational
- Higher rate in prospective studies suggests under-detection in retrospective ones
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
Abstract only.
9. Assessment of the statistical interpretation
Proportion; prospective vs retrospective difference indicates detection bias.
10. Relevance to the specific claim
Calibrates severity: most post-sleeve oesophagitis is mild.
11. Independent contrary findings
Prospective studies give 7%.
12. Transferability to Germany and Europe
International.
13. Overall methodological judgement
Useful severity estimate; limits worst-case interpretations.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | unknown |
| Consistency with the overall evidence | unknown |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Long-term progression.
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 substantially increases gastro-oesophageal reflux disease and erosive oesophagitis. – Studies with mixed or unclear results