Roux-en-Y Gastric Bypass As a Treatment for Barrett's Esophagus After Sleeve Gastrectomy

Overview

Journal Obes Surg

Date 2019 Dec 7

PMID 31808119

Citations 21

Authors

Daniel M Felsenreich

Felix B Langer

Christoph Bichler

Magdalena Eilenberg

Julia Jedamzik

Ivan Kristo

Natalie Vock

Lisa Gensthaler

Charlotte Rabl

Alexander Todoroff

Gerhard Prager

Affiliations

Soon will be listed here.

Abstract

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. 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.

Citing Articles

Bariatric surgery and relevant comorbidities: a systematic review and meta-analysis.

Wunker C, Kumar S, Hallowell P, Collings A, Loss L, Bansal V Surg Endosc. 2025; 39(3):1419-1448.

PMID: 39920373 PMC: 11870965. DOI: 10.1007/s00464-025-11528-4.

RESULTS OF MECHANIC VERSUS MOTORIZED STAPLER USED IN GASTRIC SURGERY: PROSPECTIVE STUDY.

Braghetto I, Czwiklitzer G, Korn O, Brante P, Burgos A Arq Bras Cir Dig. 2024; 37:e1818.

PMID: 39230118 PMC: 11363907. DOI: 10.1590/0102-6720202400025e1818.

Challenges of Revisional Metabolic and Bariatric Surgery: A Comprehensive Guide to Unraveling the Complexities and Solutions of Revisional Bariatric Procedures.

Evans L, Castillo-Larios R, Cornejo J, Elli E J Clin Med. 2024; 13(11).

PMID: 38892813 PMC: 11172990. DOI: 10.3390/jcm13113104.

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.

GERD after Bariatric Surgery: A Review of the Underlying Causes and Recommendations for Management.

Pletch A, Lidor A Curr Gastroenterol Rep. 2024; 26(4):99-106.

PMID: 38353898 DOI: 10.1007/s11894-024-00919-7.

References

Levine D, Blount P, Rudolph R, Reid B . Safety of a systematic endoscopic biopsy protocol in patients with Barrett's esophagus. Am J Gastroenterol. 2000; 95(5):1152-7. DOI: 10.1111/j.1572-0241.2000.02002.x. View

Gagner M . Is Sleeve Gastrectomy Always an Absolute Contraindication in Patients with Barrett's?. Obes Surg. 2015; 26(4):715-7. DOI: 10.1007/s11695-015-1983-1. View

Hirth D, Jones E, Rothchild K, Mitchell B, Schoen J . Laparoscopic sleeve gastrectomy: long-term weight loss outcomes. Surg Obes Relat Dis. 2015; 11(5):1004-7. DOI: 10.1016/j.soard.2015.02.016. View

Arman G, Himpens J, Dhaenens J, Ballet T, Vilallonga R, Leman G . Long-term (11+years) outcomes in weight, patient satisfaction, comorbidities, and gastroesophageal reflux treatment after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016; 12(10):1778-1786. DOI: 10.1016/j.soard.2016.01.013. View

Kindel T, Oleynikov D . The Improvement of Gastroesophageal Reflux Disease and Barrett's after Bariatric Surgery. Obes Surg. 2016; 26(4):718-20. DOI: 10.1007/s11695-016-2116-1. View

Csendes A, Burgos A, Smok G, Burdiles P, Henriquez A . Effect of gastric bypass on Barrett's esophagus and intestinal metaplasia of the cardia in patients with morbid obesity. J Gastrointest Surg. 2006; 10(2):259-64. DOI: 10.1016/j.gassur.2005.06.006. View

Sohn S, Fischer J, Booth M . Adenocarcinoma of the gastro-oesophageal junction after sleeve gastrectomy: a case report. ANZ J Surg. 2015; 87(10):E163-E164. DOI: 10.1111/ans.13064. View

Braghetto I, Csendes A . Prevalence of Barrett's Esophagus in Bariatric Patients Undergoing Sleeve Gastrectomy. Obes Surg. 2015; 26(4):710-4. DOI: 10.1007/s11695-015-1574-1. View

Sebastianelli L, Benois M, Vanbiervliet G, Bailly L, Robert M, Turrin N . Systematic Endoscopy 5 Years After Sleeve Gastrectomy Results in a High Rate of Barrett's Esophagus: Results of a Multicenter Study. Obes Surg. 2019; 29(5):1462-1469. DOI: 10.1007/s11695-019-03704-y. View

10.

Houghton S, Romero Y, Sarr M . Effect of Roux-en-Y gastric bypass in obese patients with Barrett's esophagus: attempts to eliminate duodenogastric reflux. Surg Obes Relat Dis. 2007; 4(1):1-4. DOI: 10.1016/j.soard.2007.10.003. View

11.

Ronkainen J, Aro P, Storskrubb T, Johansson S, Lind T, Bolling-Sternevald E . Prevalence of Barrett's esophagus in the general population: an endoscopic study. Gastroenterology. 2005; 129(6):1825-31. DOI: 10.1053/j.gastro.2005.08.053. View

12.

Markar S, Arhi C, Leusink A, Vidal-Diez A, Karthikesalingam A, Darzi A . The Influence of Antireflux Surgery on Esophageal Cancer Risk in England: National Population-based Cohort Study. Ann Surg. 2018; 268(5):861-867. DOI: 10.1097/SLA.0000000000002890. View

13.

Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J . IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg. 2018; 28(12):3783-3794. DOI: 10.1007/s11695-018-3450-2. View

14.

Spivak H, Rubin M, Sadot E, Pollak E, Feygin A, Goitein D . Laparoscopic sleeve gastrectomy using 42-French versus 32-French bougie: the first-year outcome. Obes Surg. 2014; 24(7):1090-3. DOI: 10.1007/s11695-014-1199-9. View

15.

Musella M, Berardi G, Bocchetti A, Green R, Cantoni V, Velotti N . Esophagogastric Neoplasms Following Bariatric Surgery: an Updated Systematic Review. Obes Surg. 2019; 29(8):2660-2669. DOI: 10.1007/s11695-019-03951-z. View

16.

Yeung K, Penney N, Ashrafian L, Darzi A, Ashrafian H . Does Sleeve Gastrectomy Expose the Distal Esophagus to Severe Reflux?: A Systematic Review and Meta-analysis. Ann Surg. 2019; 271(2):257-265. DOI: 10.1097/SLA.0000000000003275. View

17.

Genco A, Soricelli E, Casella G, Maselli R, Castagneto-Gissey L, Lorenzo N . Gastroesophageal reflux disease and Barrett's esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis. 2017; 13(4):568-574. DOI: 10.1016/j.soard.2016.11.029. View

18.

Felsenreich D, Langer F, Prager G . Reply to the Letter to the Editor "Does Sleeve Gastrectomy Cause Barrett's Oesophagus?". Obes Surg. 2018; 28(12):4051-4052. DOI: 10.1007/s11695-018-3542-z. View

19.

Casillas R, Um S, Zelada Getty J, Sachs S, Kim B . Revision of primary sleeve gastrectomy to Roux-en-Y gastric bypass: indications and outcomes from a high-volume center. Surg Obes Relat Dis. 2016; 12(10):1817-1825. DOI: 10.1016/j.soard.2016.09.038. View

20.

Felsenreich D, Ladinig L, Beckerhinn P, Sperker C, Schwameis K, Krebs M . Update: 10 Years of Sleeve Gastrectomy-the First 103 Patients. Obes Surg. 2018; 28(11):3586-3594. DOI: 10.1007/s11695-018-3399-1. View