94 Meta-Analysis of GERD-Related Outcomes Following Roux-en-Y Gastric Bypass (RYGB) Versus One Anastomosis Gastric Bypass (OAGB): Evidence In Favour of Better Outcomes with RYGB Over OAGB in Patients with Pre-Existing GERD

Abstract Aim To evaluate GERD-related outcomes following Roux-en-Y gastric bypass (RYGB) versus One Anastomosis Gastric Bypass (OAGB) in both primary and revisional bariatric surgeries, with the aim of determining the comparative outcomes with the 2 commonly performed revisional procedures in patients with established GERD. Method A systematic search of Medline, Embase, CINAHL, CENTRAL, Web of Science, and relevant registries was performed. A random-effects meta- analysis was undertaken using PRISMA guidelines to assess GERD remission, de novo GERD, GERD incidence, and endoscopically confirmed oesophagitis between RYGB and OAGB. Results Twenty-one observational studies were included with a total of 4143 patients who underwent either primary or revisional bariatric surgery. GERD remission was more likely following RYGB compared to OAGB in both primary surgery and revision from sleeve gastrectomy (OR= 2.48, 95% CI = [1.04, 5.89], P=0.04). The odds of de novo GERD were significantly higher after OAGB in both primary surgery and revision settings (OR= 0.30, 95% CI = [0.12, 0.74], P = 0.009). The overall incidence of GERD significantly favoured RYGB over OAGB in both primary and revisional cases (OR=0.32, 95% CI = [0.18, 0.58], P = 0.0002). Endoscopically proven oesophagitis was significantly more frequent in OAGB (OR = 0.53, 95% CI = [0.26, 1.08], P=0.08). Conclusions OAGB is associated with higher rates of de novo GERD, increased GERD incidence, and more frequent endoscopic evidence of oesophagitis when compared to RYGB. These findings suggest that OAGB should be used with caution in patients known GERD or to be considered with a close postoperative surveillance.