Barrett's Esophagus Before and After Roux-en-Y Gastric Bypass for Severe Obesity

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2017 Aug 6

PMID 28779257

Citations 19

Authors

Brandon Andrew

Joshua B Alley

Cristina E Aguilar

Robert D Fanelli

Affiliations

Soon will be listed here.

Abstract

Introduction: Barrett's esophagus (BE) has been associated with obesity and metabolic syndrome. Laparoscopic Roux-en-Y gastric bypass (LRYGB) may represent a surgical approach which addresses both severe obesity and BE. LRYGB diverts bile away from the gastric pouch and esophagus due to the long Roux limb, and very little acid is produced in the cardia-based gastric pouch. Furthermore, surgically induced weight loss may diminish systemic inflammation, which may contribute to metaplastic changes in the esophagus. Moreover, improved compliance with proton-pump inhibitor therapy, as a consequence of enrolling in a bariatric program, will decrease acid production further. Decreased duodeno-gastro-esophageal reflux should lead to decreased BE. In this study we examine the effect of LRYGB on regression of BE.

Methods And Procedures: We performed a review of all patients with biopsy proven BE, who underwent LRYGB at our institution. A total of 19 patients were identified. A subset of those patients was identified who had at least 1 year of clinical, endoscopic, or histological data, comprising a total of 14 patients. Seven of these patients had symptoms of gastroesophageal reflux. All 19 patients had short-segment BE. One patient had low-grade dysplasia.

Results: Post-LRYGB, 6 of 14 (42.9%) patients had histologic regression of BE to normal esophageal mucosa, with no evidence of ongoing BE. 13 of 14 patients (92.8%) reported compliance with continuing PPI therapy for at least the first year after surgery. Body mass index for the group of 14 patients improved from 46.6 to 30.3 kg/m.

Conclusions: We recommend LRYGB as an effective combined bariatric and anti-reflux surgical procedure for patients with severe obesity and BE. In short-term follow-up, LRYGB achieved endoscopic and histologic regression to normal mucosa in a substantial number of the patients in our series. Long-term follow-up for patients with BE according to standard surveillance protocols is still recommended.

Citing Articles

Reflux, Barrett's Esophagus, and Esophageal Adenocarcinoma After Bariatric Surgery.

Medina B, Molena D Foregut. 2024; 1(4):393-400.

PMID: 38646141 PMC: 11031263. DOI: 10.1177/26345161211068367.

Treatment of esophageal adenocarcinoma in patients with a history of bariatric surgery.

Nobel T, Sewell M, Boerner T, Bains M, Bott M, Gerdes H J Gastrointest Surg. 2024; 28(4):337-342.

PMID: 38583881 PMC: 11212035. DOI: 10.1016/j.gassur.2024.01.028.

Barrett`s Esophagus in Bariatric Surgery: Regression or Progression?.

Moulla Y, Hamadeh H, Seidemann L, Mehdorn M, Bluher M, Feisthammel J Obes Surg. 2023; 33(11):3391-3401.

PMID: 37776419 DOI: 10.1007/s11695-023-06829-3.

GERD-screening before bariatric surgery: the predictive value of the GERD-HRQL questionnaire score compared with preoperative EGD findings.

Allotey J, Caposole M, Attia A, Coonan E, Noguera V, Lewis E Surg Endosc. 2023; 37(12):9572-9581.

PMID: 37730853 DOI: 10.1007/s00464-023-10388-0.

Y Not Roux-en-Y?: Resolution of Barrett's Esophagus After Surgical Conversion of Gastric Sleeve in Two Patients.

Castagneto-Gissey L, Gualtieri L, Diddoro A, Lauro A, Genco A, Casella G Dig Dis Sci. 2023; 68(5):1698-1704.

PMID: 36853549 DOI: 10.1007/s10620-023-07874-9.

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