Guideline / position statementindependent cross-checkabstract checked I-BAR-113 standard review
International experts on reflux and sleeve
Gastroesophageal Reflux and Laparoscopic Sleeve Gastrectomy: Results of the First International Consensus Conference.
Overview
Assalia et al.. Obes Surg 2020 · PMID 32533520 · DOI 10.1007/s11695-020-04749-0
Experts agreed that reflux is probably the main drawback of sleeve and that bypass is preferable when severe reflux exists.
Does the study support the specific claim? Partly · Methodological quality: low
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Agree on GERD management
- How was the study done?
Expert consensus
- How many people, animals or samples were studied?
46 experts
- What was actually found?
Endoscopy before/after; bypass for severe GERD
- How large was the observed effect?
Agreement %
- What do the results mean in everyday life?
Doctors take reflux after sleeve seriously
- What are the study's limitations?
Opinion-based
- What does it say about Elawady's specific claim?
Supports reflux concern
- Do the results apply to Germany and Europe?
International
- What can explicitly not be concluded from this study?
Does not condemn sleeve generally
Scientific in-depth review
1. Full reference
- Authors
- Assalia et al.
- Journal
- Obes Surg
- Year
- 2020
- Identifier
- PMID 32533520 DOI 10.1007/s11695-020-04749-0
- 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 should GERD before and after sleeve gastrectomy be managed?
3. Study design and population
- Study design
- Guideline / position statement – International expert consensus conference (modified Delphi questionnaire)
- Population
50 bariatric experts from 25 countries
- Country
International (Montpellier, France meeting)
- Period
June 2019
- Sample size
46 responding experts
- Inclusion and exclusion criteria
Invited experts
4. Methods and endpoints
- Exposure / intervention
Sleeve gastrectomy in relation to GERD
- Comparator
not applicable
- Endpoints
Consensus statements
- Statistical methods
Agreement percentages
5. Actual results
- Results
GERD described as probably the main drawback of LSG. EGD considered mandatory before (92%) and after (78%) surgery. Higher grades of erosive oesophagitis (94%) and Barrett oesophagus (96%) seen as contraindications to LSG. RYGB recommended for uncontrolled post-sleeve GERD (84%/76%) and Barrett (78%).
- Absolute risks
not applicable
- Authors' conclusion
LSG is viewed as contraindicated in higher degrees of endoscopic and clinical GERD; pre- and postoperative endoscopy emphasised.
6. Strengths
- Broad international expert panel
7. Weaknesses
- Expert opinion, not systematic evidence grading
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Consensus statement.
9. Assessment of the statistical interpretation
not applicable
10. Relevance to the specific claim
Experts themselves acknowledge sleeve-related GERD as the main drawback and prefer bypass when GERD is significant - consistent with Elawady's reflux point and his 2021 preference for bypass in reflux.
11. Independent contrary findings
Not a recommendation against sleeve in general.
12. Transferability to Germany and Europe
International.
13. Overall methodological judgement
Confirms the reflux concern is mainstream.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | low |
| Risk of bias | not assessable |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | unknown |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Surveillance intervals.
15. Linked fact checks
- Sleeve gastrectomy substantially increases gastro-oesophageal reflux disease and erosive oesophagitis. – Studies supporting the claim
- Gastric bypass is preferable to sleeve gastrectomy (less reflux) and can fully treat type 2 diabetes; for patients who fail dieting, bypass rather than sleeve should be chosen (2021 statement). – Studies supporting the claim