Mechanistic and clinical outcomes of a surgical innovation aimed at minimizing GERD associated with vertical sleeve gastrectomy (INNOVATE-VSG)
Details
The study will examine whether a modified vertical sleeve gastrectomy (mVSG) will improve GERD and quality of life.
Aim 1 (Primary): to determine whether mVSG, in comparison to conventional vertical sleeve gastrectomy (cVSG), will be associated with lower acid exposure time (AET, measured by the Bravo pH test) at 6-9 months. The investigators hypothesize that, at Month 6-9, compared to cVSG:
- H1. mVSG will be associated with lower AET
Aim 2 (Secondary): To elucidate the mechanistic basis for Aim 1, the investigators will perform following tests, before and at 6-9 months post-surgery: a) High resolution esophageal manometry (HREM) to determine the lower esophageal sphincter (LES) and intragastric pressure; b) The endoluminal functional lumen imaging probe (EndoFLIP) testing to examine changes in compliance of the LES; c) Measure the length of the gastroesophageal flap valve (GEFV) on the retroflex view during endoscopic exam. The investigators hypothesize that, at Month 6-9, compared to cVSG:
- H2a. mVSG will be associated with higher LES pressure and lower intragastric pressure
- H2b. mVSG will be associated with lower LES compliance
- H2c. GEFV will be present after mVSG (vs absence after cVSG)
Aim 3: Examine the impact of GERD on quality of life (QoL) with two validated rating scales - Gastroesophageal reflux disease-health related quality of life (GERD-HRQL) and Short Form-36 (SF-36). The investigators hypothesize that, at 12 months, compared to cVSG:
- H3. mVSG will lead to superior QoL
Eligibility
You can join if...
Inclusion Criteria:
Male and female subjects aged 18-60 years
Body mass index (BMI) 35-50 kg/m2
Must meet the BMI criteria before and after 6 months of nonsurgical weight management
Presence of GERD defined for this trial as acid exposure time (AET) of 4.9% or above as assessed with the Bravo pH test.
Have health insurance which pays for the costs of bariatric surgery and standard medical care before and after surgery
Women of childbearing potential must be using appropriate contraception to avoid pregnancy throughout the study, and must have a negative pregnancy test at study entry and prior to surgery
Must be able to provide written informed consent
Exclusion Criteria:
Hiatal hernia greater than 2cm (defined as maximum axial height from end of the esophagus to diaphragm by any study including upper endoscopy esophagram and or at the time of surgery)
Evidence of clinically significant major esophageal motility disorder as determined by the site primary investigator
Severe gastroparesis
Previous bariatric or anti-reflux procedure
Barrett's esophagus
Subjects requiring mesh treatment at time of procedure
Severe heart (e.g., severe heart failure, unstable coronary artery disease), or end-stage lung disease as determined by the site primary investigator
Subjects with pacemakers, implantable defibrillators, neurostimulators
Portal hypertension or cirrhosis
Chronic pancreatitis
Active cancer treatment
Inability to tolerate general anesthesia
Uncontrollable coagulopathy
Significant and uncontrolled inflammatory bowel disease
Severe and/or uncontrolled psychiatric disorder (including psychosis, bipolar disorder) as determined during standard pre-surgery psychiatric screening at the site.
Suicidal ideation or unstable/untreated major depressive disorder within the past year
Alcohol or substance use disorder within the past year.
Pregnant or breastfeeding or planning pregnancy in the coming 24 months
Diminished intellectual capacity to consent or follow pre- and post-surgery instructions
History of, or any current health condition that, in the opinion of the PI, would make the subject ineligible for sleeve gastrectomy, or put the subject at risk by participation in the study.