Gastroesophageal Reflux Disease After Sleeve Gastrectomy versus Roux‐en‐Y Gastric Bypass: An 8‐Year Prospective Cohort Study

ABSTRACT Background The long‐term impact of bariatric procedures on gastroesophageal reflux disease (GERD) remains insufficiently characterized. Sleeve gastrectomy (LSG) is technically simpler but may predispose patients to reflux, whereas Roux‐en‐Y gastric bypass (LRYGB) is recognized for its durable anti‐reflux effect. Robust prospective data comparing the procedures beyond 5 years are scarce. This study compared 8‐year persistent or new‐onset GERD after LSG versus LRYGB using multimodal assessment based on Lyon Consensus 2.0 criteria. Methods In this prospective dual‐cohort extension of a previous trial ( n = 75), 51 patients (LSG = 19; LRYGB = 32) completed 8‐year follow‐up. Multimodal assessment included a symptom questionnaire, upper endoscopy, contrast radiology, manometry, and 24‐h pH monitoring. The primary endpoint was conclusive GERD per Lyon 2.0 classification. Results Conclusive GERD was present in 94.7% of LSG patients compared with 25.0% following LRYGB (RR = 3.8; 95% CI, 2.06–6.97). Erosive esophagitis (Los Angeles grade ≥ B) was more frequent after LSG (73.7% vs. 18.8%; p 14.7) occurred in 66.7% of LSG patients versus 19.0% after LRYGB (RR = 3.44; p = 0.002). GERD‐related complications, including Barrett's esophagus and conversion to LRYGB, were observed only after LSG. Conclusion At 8‐year follow‐up, LSG is strongly associated with persistent or de novo GERD, whereas LRYGB maintains a durable protective effect. These findings highlight the relevance of appropriate preoperative evaluation and long‐term reflux surveillance when selecting bariatric procedures. Trial Registration ClinicalTrials.gov Identifier: NCT03692455