Patients with Systemic Sclerosis Seeking Metabolic and Bariatric Surgery: Which Operation to Perform?

Background: Systemic sclerosis (scleroderma) is a rare progressive autoimmune disease that affects the gastrointestinal (GI) system. Given the increasing prevalence of obesity, selecting the appropriate metabolic and bariatric operation (MBS) in these patients present a unique challenge to bariatric surgeons. Objectives: To evaluate the long-term outcomes of MBS in patients with scleroderma. Methods: We report 1-year outcomes (esophageal dysmotility, weight loss, and complications) of two patients with scleroderma and obesity who underwent sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) at our institution. We also review the literature regarding benign upper GI surgery in patients with scleroderma. Setting: This study was performed in University hospital settings at Kingston Health Sciences Center, Canada. Results: We identified two patients with severe obesity and scleroderma. Patient #1 was a 61-year-old female with a body mass index (BMI) of 41.6 kg/m 2 . She had mild esophageal dysmotility without clear evidence of scleroderma esophagus and underwent a SG. On follow-up, she developed scleroderma esophagus with progressive dysphagia and recurrent aspirations. She was converted to RYGB with satisfactory weight loss and improvement in her GI symptoms. Patient #2 was a 61-year-old female with a BMI of 46 kg/m 2 . She had scleroderma esophagus on initial assessment and underwent a RYGB with excellent control of her GI symptoms and satisfactory weight loss. Conclusion: RYGB is the preferred MBS in patients with scleroderma and obesity given the progressive nature of scleroderma. SG should be avoided as patients will likely go on to develop scleroderma esophagus and present with worsening reflux, dysphagia, and aspirations.