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Barrett's Esophagus After Sleeve Gastrectomy
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND AND AIMS
Sleeve gastrectomy (SG) has seen significant growth in recent years. Gastroesophageal reflux disease (GERD) is a major concern in patients undergoing SG and is the major risk factor for Barrett's esophagus (BE). We aimed to assess the prevalence of BE in patients who had SG.
METHODS
We searched major search engines ending in July 2020. We included studies on patients who had esophagogastroduodenoscopy (EGD) after SG. The primary outcome was the prevalence of BE in patients who had SG. We assessed heterogeneity using I2 and Q statistics. We used funnel plots and classic fail-safe to assess for publication bias. We used random-effects modeling to report effect estimates.
RESULTS
Our final analysis included 10 studies totaling 680 patients who had EGD 6 months to 10 years after SG. The pooled prevalence of BE was 11.6% (95% CI, 8.1 -16.4%; p<0.001; I2=28.7%). On logistic meta-regression analysis, there was no significant association between BE and the prevalence of postoperative GERD (β= 3.5; 95% CI, -18 - 25p; p=0.75). There was a linear relationship between the time of postoperative EGD and the rate of esophagitis (β= 0.13; 95% CI, 0.06 - 0.20; p=0.0005); the risk of esophagitis increased by 13% each year after SG.
CONCLUSIONS
The prevalence of BE in patients who had EGD after SG appears to be high. There was no correlation with GERD symptoms. Most cases were observed after 3 years of follow-up. Screening for BE should be considered in patients after SG even in the absence of GERD symptoms postoperatively.
Additional Info
Disclosure statements are available on the authors' profiles:
Barrett's Esophagus After Sleeve Gastrectomy: A Systematic Review and Meta-Analysis
Gastrointest. Endosc. 2020 Aug 13;[EPub Ahead of Print], BJ Qumseya, Y Qumsiyeh, S Ponniah, D Estores, D Yang, CN Johnson-Mann, J Friedman, A Ayzengart, PV DraganovFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Sleeve gastrectomy (SG) is an increasingly popular surgical technique for obesity. Although effective for obesity, SG is also associated with an increase in GERD symptoms. GERD is a recognized risk factor for Barrett’s esophagus (BE), the precursor of esophageal adenocarcinoma (EAC). Qumseya et al performed a systematic review and meta-analysis to assess the risk of BE in 680 patients who underwent SG for obesity. The primary outcome was the prevalence of BE 6 months to 10 years after SG, and secondary outcomes were the prevalence of esophagitis and GERD. The pooled prevalence of BE was 11.6%, with most cases diagnosed within 3 years and lack of an association between BE and postoperative GERD symptoms. There was a 35% and 86% increase in the risk of esophagitis on short- and long-term follow-up after SG. The authors have previously shown that the risk of BE in over 13,000 patients undergoing EGD before bariatric surgery was <1%. Current screening recommendations for BE are for high-risk (family history of EAC or BE) and moderate-risk (GERD and at least one additional risk factor: age >50 years, obesity/central adiposity, history of smoking, or male gender) groups. This study has several clinical implications. High BE prevalence post SG suggests that this may be a high-risk population that would benefit from screening. Acid suppression therapy should be considered to mitigate the risk of BE, regardless of symptoms. Although further studies are needed, this important study quantifies unintended, potentially deadly, long-term consequences of SG that need to be discussed with our patients.