S766 Evolving Sleeve Anatomy and Esophagitis Post-Sleeve Gastrectomy: A Long-Term Longitudinal Endoscopic Study

Introduction: Laparoscopic sleeve gastrectomy (LSG) can lead to anatomical changes that may contribute to gastroesophageal reflux disease and endoscopic esophagitis (EE). This study aimed to longitudinally assess the prevalence of specific anatomical alterations and their association with EE at 2 post-LSG time points. Methods: We retrospectively analyzed endoscopic findings from 343 LSG patients (61% women, mean age 41.6 ± 10.7 years, mean BMI 47.9 ± 7.4 kg/m²). Endoscopies were performed 1-4 years and ≥5 years post-LSG. Anatomical alterations included sleeve dilatation, hiatus hernia, sleeve narrowing, and twisting. Chi-square and Fisher's exact tests determined associations between alterations and EE. McNemar's test assessed temporal changes in findings within a subgroup with both early and late endoscopies. Results: At 1-4 years post-LSG, EE was present in 19%. Anatomical alterations were identified in 17% (composite), with dilatation in 6.6%, hiatus hernia in 7.8%, narrowing in 0.9%, and twisting in 3.8%. No significant association between individual anatomical findings and EE (P > 0.05). At ≥5 years, EE prevalence increased to 28%, and anatomical alterations became significantly more common, affecting 46% (sleeve dilatation 31%, hiatus hernia 17%, twisting 9.2%). No significant association between composite alterations and EE at this time point (P = 0.28). In a subgroup of 76 patients with both 1-4 and ≥5 year endoscopies: twisting significantly increased from 7.9% to 18.4% (P = 0.002); dilatation highly significantly increased from 15.2% to 38.4% (P = 0.0002). Composite anatomical alterations significantly increased from 31.1% to 63.2% (P < 0.0001). Changes in EE (P = 0.286) and hiatus hernia (P = 0.115) did not reach statistical significance in this paired analysis. Trend towards association between narrowing at 1-4 years and EE at ≥5 years (P = 0.052) was observed; no other significant correlations between early anatomical findings and late EE (P > 0.05). Conclusion: Anatomical alterations following LSG are highly prevalent and progressively increase over time, affecting nearly half of patients by 5 years. Within individuals, twisting, dilatation, and overall anatomical alterations significantly worsen over time. However, these alterations, were not significantly associated with oesophagitis at either early or late follow-up. Further long-term studies are essential to understand the clinical implications of these evolving anatomical changes after LSG.