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21 months post OP. Severe GERD. Endoscopy shows lax LES and 12 MM Antral nodule



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Developed GERD right after surgery. It was mostly controlled by diet and omeprazole until December 2020 when I began having massive issues. My PCP switched me to pantoprazole/famitodine which helped but as I was still continuing to have issues I was referred to the gastroenterologist. Gastroenterologist decided I needed both a colonscopy and endoscopy. Yesterday was the earliest they could get me in for one.

Colonscopy came back with mild diverticulitis and they are recommending I increase my Fiber and Fluid intake to manage it.

Endoscopy came back with a lax LES and a 12 MM antral nodule that has to be biopsied. Hoping the nodule comes back as benign and not cancerous. The lax LES seems to be the reason why I am having so many issues controlling GERD. I have a follow up appointment to discuss with the doctor in a few weeks.

Google is telling me linx procedure is the best option but some posts here are saying revision to bypass is better for bariatric patients.

Putting my concerns about the antral nodule aside, has anyone had any experience with a lax LES and severe reflux after VSG while at a healthy BMI? I don't want to have a revision and lose a ton more weight. I can lose more as I am in the upper range of a healthy BMI range but I am happy with my current size. Was linx reccomended to you or revision? If you had a revision did you lose a bunch more weight or just a little?

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So sorry you have developed such severe gerd.

Did they warn you to avoid seeds, unprocessed grains, nuts & corn with your diverticulitis? Some doctors just say to increase your fibre but omit to mention that seeds, unprocessed grains, etc. can get trapped in the diverticulitis pockets & cause infection & pain. Of course, as with many things it doesn’t affect everyone the same way. You may be able to eat these with little or no issue. Neither my mother or uncle can. (As he discovered after he was admitted to hospital with terrible pain & other unpleasant side effects. He had recently changed his diet to add seeds & more grains to his diet to be healthier.☹️)

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Posted (edited)

So sorry that you are dealing with these problems. I have dealt with GERD of various intensities since I had the lap-band many years ago (and since I switched to the sleeve) so I can sympathize with how terrible it can be.
I hope that the nodule results come back benign.

Here's what I have been able to learn about the situation of post-sleeve GERD:
Switching to an RNY is the best-studied option and therefore that is what many people will tell you to do, because we know it works to get rid of acid for MOST people (some people will still have problems even then, but most do not).
The Linx procedure is a newer one and there isn't yet a lot of great data on how post-sleeve people do with it. However, it is supposed to be reversible, so I think the main risks you run with getting the Linx is that #1: if it doesn't work well, you then have to go through another surgery to remove it and get the RNY and #2: there is a chance of having to deal with an erosion or scar tissue that might make the removal more complicated. If you do get the Linx, I'd definitely try to find someone who has done a lot of them and is confident about doing it. Since it is a new option not every surgeon will have done a lot of them.

Another option you may want to ask your doctor about is this procedure called a "ligamentum teres cardiopexy". Basically, they just take a ligament hanging off your liver and loop it around your esophageal sphincter to strengthen it in order to try to stop the GERD. This is something new that some surgeons are doing for sleeve patients who have GERD (since we can't have a fundoplication like "normal" people and many of us don't want the RNY). To me it seems like a less complex and easier surgery than the other options, so I am going to ask my doctor about it. Here are some articles about it if you want to show them to your surgeon:
https://www.sciencedirect.com/science/article/abs/pii/S000296102030814X
https://pubmed.ncbi.nlm.nih.gov/31175555/

Good luck with finding an answer.

Edited by SleevedK

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Nodule came back as benign but they want to remove it with an endoscopic ultrasound. My gastroenterologist says their recommendation would be revision to RNY. I had a virtual appointment with my surgeon and my surgeon is sending me for upper GI xrays in case a hernia or stricture was missed in the endoscopy,

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Upper GI barium swallow shows esophageal dysmotility and it also found a hiatal hernia that the endoscopy missed. I can't find out much about the esophogeal dysmotility googling but the radiologist said I am either going to need revision to bypass or nissen fundoplication and that the hernia will need repaired. Waiting now to see what my surgeon says.

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On 3/4/2021 at 9:24 PM, Arabesque said:

So sorry you have developed such severe gerd.

Did they warn you to avoid seeds, unprocessed grains, nuts & corn with your diverticulitis? Some doctors just say to increase your fibre but omit to mention that seeds, unprocessed grains, etc. can get trapped in the diverticulitis pockets & cause infection & pain. Of course, as with many things it doesn’t affect everyone the same way. You may be able to eat these with little or no issue. Neither my mother or uncle can. (As he discovered after he was admitted to hospital with terrible pain & other unpleasant side effects. He had recently changed his diet to add seeds & more grains to his diet to be healthier.☹️)

Avoiding seeds, etc has been studied and has not been shown to improve outcomes in patients with diverticulosis/diverticulitis overall. Meaning, it will not prevent a recurrence of symptoms to avoid seeds and grains. However, many docs still don't know this because many practicing physicians are not up to date on the latest research.

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