Evidence Table 15. Weight as modifying factor for outcomes after ARS

Author YrPre-Op Risk(s) Assessed (R)InterventionBaseline patient characteristicsFollow-up durationStatus at follow upQuality
CountryWeightEnrolled/FinalAgeExcluded ≥ grade 3 esophagitis; % ≥ grade 3pH statusResponded to PPI or H2RAEMS/Hiatal herniaChange in symptomsEsophagitis statuspH statusOff PPI/Off all anti-secretory meds↓ PPI dose or now responds to dose that failed before RxQOL/satisfactionEMS/others
SettingSex
Study design
Sandbu1 2002Low volume hospitalARS52NDNDNDND4 yrNDNDND89% low vol vs 80% high volNDIncreasing BMI correlated to patient satisfaction P=0.0006NDC
SwedenBMI 26.4220/20862% male
Public hospitalHigh volume hospitalARS54
Ambi-directional cohortBMI 26.3225/20060% male
O'Boyle 2002<70Kg 50 (22%)Nissen<40 32%22% no esophagitis13/119 (11%) abnl (>4.4%)ND116/246 (47%) hiatal hernia5 yrNo difference in post-op heartburn scores by weightNDNDNDNDNo difference in post-op satisfaction scores by weightNDC
Australia70-90Kg 123 (54%)262/26240-60 48%66% moderate esophagitis
Public hospital>90Kg 54 (24%)>60 20%11% severe esophagitis
Case-control(n=227)(n=258)(n=218)
63% male
Bell 1999NDToupetNDNDND36 PPI > 8 wks, 22 unkn meds or duration, 14 no medsNDND21 failures (15%): 19 with recurrent symptoms, 2 had dysphagiaNDNDND1 pt responding with PPINDBMI not factor for success /failureC
USA143/138ND(n=80, off meds)“pts seen up to 3 mo & every 6 mo”
HospitalDeMeester
Case-control
Winslow 2003Nl BMI<25Nissen 90%4751% Esophagitis51Majority of patients on medicationLES 10 mmHg35 moReduced symptoms of heartburn, water brash, regurgitation; no difference between groupsNDNDNDAll groups had reduced requirement for medsNo difference between groups for number of return to work days; no difference for patient satisfactionNo difference for complications, reoperation, anatomical failure; overall improvementC
USA82 (16%)Toupet 10%28% male11% Barretts34% haital hernia*
University hospital 505/505 15% Stricture
CohortOverweight BMI 25-29.94763% Esophagitis57LES 9 mmHg
210 (42%)69% male20% Barretts51% haital hernia
17% Stricture
Obese BMI ≥304853% Esophagitis59 (modified)LES 9 mmHg
212 (42%)36% male12% Barretts47% haital hernia *p=0.03
18% Stricture
Perez 2001Nl BMI<25Nissen47No100% abnl (Unkn # pts tested)All pts symptomatic failures on meds, refused life-long meds, or had structural complications of GERDHiatal hernia:34 moRecurrences of 5.1%, 5.4%, 22.9% for nl, overweight, obese p=0.03NDNDNDNDNDNDC
USA78 (42%)187/18753% male31 (17%) Barrett's86% none/small 14% >3 cm
University-based tertiary hospitalOverweight BMI 25-29.9
Cohort74 (40%)
Obese BMI ≥30
35 (19%)
Khajanchee 2004NDNissen5162% severe esophagitis93% abnl (off meds)ND58% hiatal hernia8.8 mo89% had reduction or were symptom-free; weight not factor for symptomatic failureND9.7% abnl (133/193 asymptomatic tested)NDNDNDNDC
USA223/22362% maleDeMeester (>14.7)
Private center
Case-control
Blom 2002NDNissen48 med33 (20%) Stricture; 36 (22%) Barrett'sNDNDND14Weight not factor for postop dysphagiaNDNDNDNDNDNDC
USA163/103(15-78)(Savary-Miller)Abnl > 14.72)mo
University hospital(preop dysphagia (n=60) excluded from analyses)73% maleDeMeester(med)
Case-control
Campos 1999Normal BMI 19-25: 47(24%)Nissen49 med41% erosive esophagitis; 24% Barrett's86% (abnl >14.7, off meds)Unknown meds/dose; response to acid suppression therapy:75% structurally defective LES; 70% hiatal hernia15 mo87% excellent/good & 13% poor symptomatic outcomes; weight not factor for outcomesNDNDUnknown number of pts on medsNDNDNDC
USAOverweight BMI 25-35: 144(72%)199/199(15-77)DeMeester7% complete
University hospitalSeverely obese BMI>35: 8(4%)70% male71% partial
Prospective cohort17% minor
5% none
Fraser 2001Normal BMI<25: 40(21%)Nissen47NDNDNDND3.2 yrWeight not factor for dysphagia; heartburn scores higher in normal weight group compared to overweight & obese groups p=0.001NDNDNDNDNo difference in patient satisfaction between groupsNDC
AustrialiaOverweight BMI 25-29.9: 88(45%)194/194(17-74)
University hospitalObese BMI>30: 66(34%)60% male
Ambi-directional cohortMorbidly obese & obese groups combined

1 type of procedures not specified

From: Appendix C, Evidence Tables

Cover of Comparative Effectiveness of Management Strategies For Gastroesophageal Reflux Disease
Comparative Effectiveness of Management Strategies For Gastroesophageal Reflux Disease [Internet].
Comparative Effectiveness Reviews, No. 1.
Ip S, Bonis P, Tatsioni A, et al.

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