Association between the body mass index, waist circumference, and body fat percentage with erosive esophagitis in adults with obesity after sleeve gastrectomy

Background: High anthropometric indexes before sleeve gastrectomy (SG) are associated with an increased risk of erosive esophagitis (EE) in bariatric surgery candidates. Reasons that explain how these indexes influence the development of esophageal pathology after surgery remains unclear. Objectives: To assess the association between the body mass index (BMI), waist circumference (WC), and body fat percentage (BFP) with the development of EE in adults with obesity three months after SG. Setting: Clínica Avendaño, Lima, Peru. Methods: Retrospective cohort using a database including adults with obesity who underwent SG during 2017-2020. All the patients included had an endoscopy before and after the surgery. Sociodemographic, clinical and laboratory characteristics were compared according to BMI, WC and BFP, as well as by the development of de novo esophagitis. The association was evaluated by crude and adjusted generalized linear models with the log-Poisson family. Results: From a total of 106 patients, 23 (21.7%) developed EE. We did not find significant differences in sociodemographic, clinical and laboratory characteristics between patients with de novo EE compared to those who did not develop EE. After adjustment, BMI (aRR = 0.59, 95% CI = 0.18-1.40), BFP (aRR = 0.41, 95% CI = 0.15-1.19) and WC (aRR = 0.91, 95% CI = 0.69-1.16) were not associated with the development of EE three months post SG. Conclusions: We found no association between preoperative anthropometric indexes and the development of de novo EE; therefore, morbid obesity should not be a criterion to exclude the patients to undergo SG as primary surgery because of the risk of developing EE.

背景：在减重手术候选人群体中，袖状胃切除术（sleeve gastrectomy, SG）术前较高的人体测量指标与糜烂性食管炎（erosive esophagitis, EE）风险升高相关。目前尚不清楚此类指标如何影响术后食管病变发生的具体机制。
目的：评估肥胖成人接受袖状胃切除术后3个月时，身体质量指数（body mass index, BMI）、腰围（waist circumference, WC）及体脂率（body fat percentage, BFP）与糜烂性食管炎发生风险的关联。
研究地点：秘鲁利马阿韦达尼奥诊所（Clínica Avendaño）。
方法：采用回顾性队列研究设计，纳入2017-2020年期间接受袖状胃切除术的肥胖成人患者数据库。所有纳入患者均在术前及术后接受内镜检查（endoscopy）。根据患者的身体质量指数、腰围、体脂率以及是否新发食管炎（de novo esophagitis），对其社会人口学、临床及实验室特征进行比较。采用基于对数泊松族（log-Poisson family）的粗模型与经校正广义线性模型（generalized linear model）评估上述指标与糜烂性食管炎发生风险的关联。
结果：共计纳入106例患者，其中23例（21.7%）发生糜烂性食管炎。新发食管炎患者与未发生食管炎患者的社会人口学、临床及实验室特征均无显著差异。经校正后，身体质量指数（校正相对风险adjusted relative risk, aRR=0.59，95%置信区间95% confidence interval, 95% CI=0.18~1.40）、体脂率（aRR=0.41，95%CI=0.15~1.19）及腰围（aRR=0.91，95%CI=0.69~1.16）与袖状胃切除术后3个月糜烂性食管炎的发生均无显著关联。
结论：本研究未发现术前人体测量指标与新发糜烂性食管炎存在关联；因此，不应以病态肥胖患者存在发生糜烂性食管炎的风险为由，将其排除在以袖状胃切除术作为首选手术方式的适应证之外。