To the Editor We read with interest the article by Salminen et al.¹ The authors found that laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass both resulted in good and sustainable weight loss at 10 years. Because their findings are important to current practice, several questions deserve attention.

First, a systematic gastroesophageal reflux disease symptom assessment was not performed. At 10-year follow-up, patients provided a retrospective subjective assessment between current and preoperative gastroesophageal reflux disease symptoms. It was a subjective judgment that might have caused significant heterogeneity and may not be an ideal measurement to evaluate the long-term effects of laparoscopic sleeve gastrectomy on gastroesophageal reflux disease. Indications to perform laparoscopic sleeve gastrectomy in this group of patients should be definitively reconsidered. Therefore, a thorough evaluation of reflux symptoms as well as esophageal anatomy and pathology should be systematically undertaken in all patients considered for laparoscopic sleeve gastrectomy.