Systematic Endoscopy 5 Years After Sleeve Gastrectomy Results in a High Rate of Barrett’s Esophagus: Results of a Multicenter Study

Sebastianelli, Luca; Benois, Marine; Vanbiervliet, Geoffroy; Bailly, Laurent; Robert, M.; Turrin, Nicolas P.; Gizard, Emmanuel; Foletto, Mirto; Bisello, Marco; Albanese, Alessio; Santonicola, Antonella; Iovino, Paola; Piche, Thierry; Angrisani, Luigi; Turchi, Laurent; Schiavo, Luigi; Iannelli, Antonio

doi:10.1007/s11695-019-03704-y

Cited by 200 publications

(83 citation statements)

References 33 publications

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“…Nineteen patients were suffering from preoperative symptomatic reflux. The authors report weight loss failure to have been significantly linked to BE and suggest providing systematic endoscopy in SG patients [7]. A very early occurrence of BE was found in the present study as well, with BE diagnosed after a mean 40.1 months after SG.…”

Section: Barrett's Esophagus After Sleeve Gastrectomysupporting

confidence: 77%

“…While research has shown many times that SG is highly efficient in achieving weight loss in short-and midterm follow-up periods [2][3][4], a few long-term studies quite recently have also found that a significant number of SG patients do suffer from reflux and weight regain in a long-term follow-up. Some of them may develop esophagitis and even Barrett's esophagus (BE) [5][6][7]. These studies have also shown that a large percentage of patients were in need of a conversion to a different bariatric procedure [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Roux-en-Y Gastric Bypass as a Treatment for Barrett’s Esophagus after Sleeve Gastrectomy

et al. 2019

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Background Laparoscopic sleeve gastrectomy (SG) is the most frequently performed bariatric procedure today. While an increasing number of long-term studies report the occurrence of Barrett's esophagus (BE) after SG, its treatment has not been studied, yet. Objectives The aim of this study was to evaluate Roux-en-Y gastric bypass (RYGB) as treatment for BE and reflux after SG. Setting University hospital setting, Austria Methods This multi-center study includes all patients (n = 10) that were converted to RYGB due to BE after SG in Austria. The mean interval between SG and RYGB was 42.7 months. The follow-up after RYGB in this study was 33.4 months. Gastroscopy, 24 h pH-metry, and manometry were performed and patients were asked to complete the BAROS and GIQLI questionnaires. Results Weight and BMI at the time of SG was 120.8 kg and 45.1 kg/m 2. Eight patients (80.0%) went into remission of BE after the conversion to RYGB. Two patients had RYGB combined with hiatoplasty. The mean acid exposure time in 24 h decreased from 36.8 to 3.8% and the mean DeMeester score from 110.0 to 16.3. Patients scored 5.1 on average in the BAROS after conversion from SG to RYGB which denotes a very good outcome. Conclusions RYGB is an effective therapy for patients with BE and reflux after SG. Its outcomes in the current study were BE remission in the majority of cases as well as a decrease in reflux activity. Further studies with larger cohorts are necessary to confirm these findings.

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Section: Barrett's Esophagus After Sleeve Gastrectomysupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Roux-en-Y Gastric Bypass as a Treatment for Barrett’s Esophagus after Sleeve Gastrectomy

et al. 2019

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“…Esophageal adenocarcinoma is in fact the most common malignancy emerging after SG and this might occur on previous metaplasia. However, to this regard, reported cases in literature are sporadic and do not allow to make definitive conclusions on the actual prevalence of such malignancies (70).…”

Section: Bariatric/metabolic Surgery and New Onset Of Gastroesophageamentioning

confidence: 99%

“…Earlier investigations suggest that biliary or mixed types of gastroesophageal reflux are responsible for esophageal mucosal injury contributing to the development of Barrett's esophagus (69). Several studies actually reported a significantly elevated number of Barrett's esophagus after SG (66,67,70), reaching a prevalence as high as 18.8% 5 years after this bariatric operation (70). Barrett's esophagus is considered to be a precancerous lesion and some authors have suggested that this histological alteration might evolve to dysplasia even more rapidly after SG (66,69).…”

Section: Bariatric/metabolic Surgery and New Onset Of Gastroesophageamentioning

confidence: 99%

“…Barrett's esophagus is indeed a precancerous lesion and some authors have suggested that this histological alteration might evolve to dysplasia even more rapidly after this operation (66,67). Esophageal adenocarcinoma is in actual fact the most common malignancy emerging after SG and postoperative endoscopic surveillance is fundamental for early diagnosis in this group of patients (69,70,77).…”

Section: Does Gerd Contraindicate Specific Bariatric Procedures?mentioning

confidence: 99%

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Obesity Surgery and Cancer: What Are the Unanswered Questions?

et al. 2020

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Obesity has become a global epidemic with a soaring economic encumbrance due to its related morbidity and mortality. Amongst obesity-related conditions, cancer is indeed the most redoubtable. Bariatric surgery has been proven to be the most effective treatment for obesity and its associated metabolic and cardiovascular disorders. However, the understanding of whether and how bariatric surgery determines a reduction in cancer risk is limited. Obesity-related malignancies primarily include colorectal and hormone-sensitive (endometrium, breast, prostate) cancers. Additionally, esophago-gastric tumors are growing to be recognized as a new category mainly associated with post-bariatric surgery outcomes. In fact, certain types of surgical procedures have been described to induce the development and subsequent progression of pre-cancerous esophageal and gastric lesions. This emerging category is of great concern and further research is required to possibly prevent such risks. Published data has generated conflicting results. In fact, while overall cancer risk reduction was reported particularly in women, some authors showed no improvement or even increased cancer incidence. Although various studies have reported beneficial effects of surgery on risk of specific cancer development, fundamental insights into the pathogenesis of obesity-related cancer are indispensable to fully elucidate its mechanisms.

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Risk of Esophageal and Gastric Cancer After Bariatric Surgery

et al. 2023

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ImportanceBariatric surgery has been associated with a reduced risk of cancer in individuals with obesity. The association of bariatric surgery with esophageal and gastric cancer is still controversial, however.ObjectiveTo compare the incidence of esophageal and gastric cancer between patients with obesity who underwent bariatric surgery and those who did not (control group).Design, Setting, and ParticipantsThis cohort study obtained data from a national discharge database, including all surgical centers, in France from January 1, 2010, to December 31, 2017. Participants included adults (aged ≥18 years) with severe obesity who underwent bariatric surgery (surgical group) or who did not (control group). Baseline characteristics were balanced between groups using nearest neighbor propensity score matching with a 1:2 ratio. The study was conducted from March 1, 2020, to June 30, 2021.ExposuresBariatric surgery (adjustable gastric banding, gastric bypass, and sleeve gastrectomy) vs no surgery.Main Outcomes and MeasuresThe main outcome was incidence of esophageal and gastric cancer. A secondary outcome was overall in-hospital mortality.ResultsA total of 303 709 patients who underwent bariatric surgery (245 819 females [80.9%]; mean [SD] age, 40.2 [11.9] years) were matched 1:2 with 605 140 patients who did not receive surgery (500 929 females [82.8%]; mean [SD] age, 40.4 [12.5] years). After matching, the 2 groups of patients were comparable in terms of age, sex, and comorbidities (standardized mean difference [SD], 0.05 [0.11]), with some differences in body mass index. The mean follow-up time was 5.62 (2.20) years in the control group and 6.06 (2.31) years in the surgical group. A total of 337 patients had esophagogastric cancer: 83 in the surgical group and 254 in the control group. The incidence rates were 6.9 per 100 000 population per year for the control group and 4.9 per 100 000 population per year for the surgical group, resulting in an incidence rate ratio of 1.42 (95% CI, 1.11-1.82; P = .005). The hazard ratio (HR) of cancer incidence was significantly in favor of the surgical group (HR, 0.76; 95% CI, 0.59-0.98; P = .03). Overall mortality was significantly lower in the surgical group (HR, 0.60; 95% CI, 0.56-0.64; P &lt; .001).Conclusions and RelevanceIn this large, nationwide cohort of patients with severe obesity, bariatric surgery was associated with a significant reduction of esophageal and gastric cancer incidence and overall in-hospital mortality, which suggests that bariatric surgery can be performed as treatment for severe obesity without increasing the risk of esophageal and gastric cancer.

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Systematic Endoscopy 5 Years After Sleeve Gastrectomy Results in a High Rate of Barrett’s Esophagus: Results of a Multicenter Study

Cited by 200 publications

References 33 publications

Roux-en-Y Gastric Bypass as a Treatment for Barrett’s Esophagus after Sleeve Gastrectomy

Roux-en-Y Gastric Bypass as a Treatment for Barrett’s Esophagus after Sleeve Gastrectomy

Obesity Surgery and Cancer: What Are the Unanswered Questions?

Risk of Esophageal and Gastric Cancer After Bariatric Surgery

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