How to manage sleeve complications through endoscopy: Gastroesophageal reflux disease

Gastroesophageal Reflux Disease (GERD) remains a common symptom for patients after laparoscopic sleeve gastrectomy. Recent literature has demonstrated that approximately one-fourth of patients may develop de novo GERD after sleeve gastrectomy. As such, proper recognition of this entity, understanding of underlying mechanisms, and knowledge regarding appropriate treatments are critical. In this review, we highlight the mechanisms that predispose to GERD post-laparoscopic sleeve gastrectomy as well as discuss the role of medical and endoscopic therapies currently available. Although surgical conversion to Roux-en-Y gastric bypass may be a treatment option for sleeve patients with refractory GERD, one potential endoscopic alternative is called anti-reflux mucosectomy (ARMS). While there is currently limited literature for endoscopic options for the treatment of GERD in the post-sleeve gastrectomy population, we review the data for ARMS, radiofrequency ablation to the lower esophageal sphincter via a procedure call Stretta, and discuss the use of transoral incisionless fundoplication (TIF) using the EsophyX device. Ultimately, current endoscopic these procedures require more data before increased adoption to patients with sleeve gastrectomy.