Correlation of the endoscopic esophagogastric junction integrity with symptomatic gerd in patients undergoing work-up for metabolic and bariatric surgery

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dc.contributor.authorŞişik, Abdullah
dc.contributor.authorDalkılıç, Muhammed Said
dc.contributor.authorGençtürk, Mehmet
dc.contributor.authorYılmaz, Merih
dc.contributor.authorErdem, Hasan
dc.contributor.authorNguyen, Ninh T.
dc.date.accessioned2026-06-03T12:09:10Z
dc.date.available2026-06-03T12:09:10Z
dc.date.issued2025
dc.departmentMeslek Yüksekokulu, Gedik Meslek Yüksekokulu, Anestezi Programı
dc.departmentFakülteler, Sağlık Bilimleri Fakültesi, Hemşirelik Bölümü
dc.description.abstractBackgroundGastroesophageal reflux disease (GERD) is a common adverse effect after metabolic and bariatric surgery (MBS). Identifying patients with preexisting GERD is critical for preoperative planning. The American Foregut Society (AFS) recently proposed a new endoscopic classification system for objective assessment of the esophagogastric junction (EGJ) integrity, building upon the Hill classification. Grade 1 represents an intact EGJ, while grades 2, 3, and 4 represent partial, moderate, and complete disruption of the ARB. Unlike Hill classification, the AFS classification includes objective measurement of hiatal axial length and aperture diameter. The study aimed to evaluate the ability of the AFS hiatus classification to predict GERD severity using symptom questionnaires.MethodsWe performed a prospective study of obese patients who underwent endoscopy as work-up for MBS. The endoscopy was evaluated for esophagitis, Barrett's esophagus, and AFS grade. All patients were also surveyed preoperatively with the GERD-HRQL, GerdQ, and RSI. The correlation between AFS grades and questionnaire scores was analyzed using Spearman's test.ResultsA total of 393 patients were included in the study. There were 81% female, with a mean age of 36 +/- 10.7 years and a mean BMI of 41.7 +/- 7.2 kg/m2. The AFS grades were distributed as follows: 11 (2.8%) patients had grade 1; 137 (34.9%) had grade 2; 162 (41.2%) had grade 3; and 83 (21.1%) had grade 4. There was a positive but weak correlation between AFS grades and all scoring systems, including GERD-HRQL (r = 0.201), heartburn (r = 0.203), regurgitation (r = 0.212), RSI (r = 0.110), and GerdQ scores (r = 0.202). However, the proportion of patients with esophagitis increased progressively with increasing grades (0% in grade 1, 2.2% in grade 2, 9.9% in grade 3, and 32.5% in grade 4, p = 0.01).ConclusionThe AFS hiatus classification can stratify the population with obesity based on rate of esophagitis and symptom scores. This study supports the practical utility of the AFS classification as an adjunct in the detection of patients who are at risk for GERD after MBS. Further validation studies with pH testing are needed.
dc.identifier.doi10.1007/s11695-024-07610-w
dc.identifier.endpage130
dc.identifier.issn0960-8923
dc.identifier.issn1708-0428
dc.identifier.issue1
dc.identifier.pmid39614976
dc.identifier.scopus2-s2.0-85210757797
dc.identifier.scopusqualityQ1
dc.identifier.startpage122
dc.identifier.urihttps://doi.org/10.1007/s11695-024-07610-w
dc.identifier.urihttps://hdl.handle.net/11501/2741
dc.identifier.volume35
dc.identifier.wosWOS:001367111600001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.institutionauthorŞişik, Abdullah
dc.language.isoen
dc.publisherSpringer
dc.relation.ispartofObesity Surgery
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.subjectEndoscopy
dc.subjectEsophagitis
dc.subjectEsophagogastric Junction
dc.subjectGastroesophageal Reflux
dc.subjectHiatal Hernia
dc.subjectMetabolic and Bariatric Surgery
dc.titleCorrelation of the endoscopic esophagogastric junction integrity with symptomatic gerd in patients undergoing work-up for metabolic and bariatric surgery
dc.typeArticle

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