Sleeve Gastrectomy Linked to High Prevalence of Barrett Esophagus

sleeve gastrectomy
sleeve gastrectomy
Patients undergoing sleeve gastrectomy sometimes develop gastroesophageal reflux disease, a major risk factor for Barrett's esophagus; therefore, researchers investigated whether patients with SG have a high rate of BE.

A study to be published in Gastrointestinal Endoscopy found a high rate of Barrett esophagus in patients who underwent sleeve gastrectomy (SG).

Studies have reported an increase in gastroesophageal reflux disease (GERD) symptoms after SG. Because GERD is a risk factor for developing Barrett esophagus (BE), the researchers wanted to explore whether SG increases the risk of developing BE.

A literature search included randomized trials; prospective, retrospective cohort studies; and meeting abstracts from the past 3 years. The search also included patients who underwent SG for treatment of obesity. All patients had esophagogastroduodenoscopy before SG. The study authors included all patients who had esophagogastroduodenoscopy or all consecutive patients who underwent esophagogastroduodenoscopy ≥6 months after surgery. If the researchers found BE, they confirmed by biopsy.

The researchers excluded studies that performed esophagogastroduodenoscopy only on symptomatic patients postoperatively rather than all patients. Case reports or case series, studies not available in English, and poor-quality studies pursuant to the Downs and Black scoring system were also excluded. Literature searches included MEDLINE (Ovid), Cochrane Library and CENTRAL, Embase, and Web of Science, from inception until July 2020.

After applying the search criteria, the study authors found 10 studies and a total of 680 patients. Of those patients, 54 patients had BE. Cases were nondysplastic, de novo. Pooled prevalence of BE was 11.4% (95% CI, 7.7-16.6%; P <.001). Analyzing studies with long-term follow-up, pooled prevalence was 11.5% (95% CI, 7.8%-16.7%); P <.001; I2=46%; and Q=11.2.

Also noted, of the patients who had BE, 7 of them had no GERD symptoms. In addition, 7 studies reported esophagitis before and after surgery. In 5 studies, the relative rate of increase of esophagitis was 86% (95% CI, 64%-109%); P <.001, I2=47%; Q=7.6 (P =.107).

Small sample size is one of the study’s limitations. Also, because the study authors intended to study BE, secondary outcome results should be “used with caution,” they advised. Using funnel plots to test for bias was less than optimal because of the low number of studies. To make up for this, the researchers also assessed using a fail-safe method.

The study authors recommended physicians undertake “careful discussion with patients regarding the risks of SG before the procedure, and the risk-benefit assessment of screening for BE after SG, should be considered.”

Dr Yang is a consultant for Boston Scientific; Lumendi; and Steris. Dr Draganov is a consultant for Boston Scientific; Cook Medical Inc.; Lumendi; Microtech; and Olympus America Inc. Dr Ayzengart is a consultant for BARD/Davol, Inc. The remaining authors declared that they have no conflict of interest.

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Qumseya BJ, Qumsiyeh Y, Ponniah S, et al. Barrett’s esophagus after sleeve gastrectomy: a systematic review and meta-analysis [published online August 13, 2020]. Gastrointest Endosc. doi: 10.1016/j.gie.2020.08.008