Barrett’s esophagus after sleeve gastrectomy: a systematic review and meta-analysis

Abstract

Background and Aims: Sleeve gastrectomy (SG) has become significantly more common 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 undergone SG. Methods: We searched the major search engines ending in July 2020. We included studies on patients who had undergone esophagogastroduodenoscopy (EGD) after SG. The primary outcome was the prevalence of BE in patients who had undergone SG. We assessed heterogeneity using I 2 and Q statistics. We used funnel plots and the classic fail-safe test to assess for publication bias. We used random-effects modeling to report effect estimates. Results: Our final analysis included 10 studies that included 680 patients who had undergone EGD 6 months to 10 years after SG. The pooled prevalence of BE was 11.6% (95% confidence interval [CI], 8.1%-16.4%; P < .001; I 2 Z 28.7%). On logistic meta-regression analysis, there was no significant association between BE and the prevalence of postoperative GERD (b Z 3.5; 95% CI, À18 to 25; P Z .75). There was a linear relationship between the time of postoperative EGD and the rate of esophagitis (b Z 0.13; 95% CI, 0.06-0.20; P Z .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. (Gastrointest Endosc 2021;93:343-52.)

Safety and early efficacy of endoscopic sleeve gastroplasty (ESG) for obesity in a multi‐ethnic Asian population in Singapore

“…One concern with gastric volume reduction following LSG is the development of de novo reflux disease and Barrett's esophagus. 21 None of our patients reported reflux symptoms or required initiation of proton pump inhibitors during the follow-up. In ESG, the anatomy as well as vascular and neural innervation of the stomach is preserved.…”

Screening for Barrett’s esophagus after sleeve gastrectomy

“…In conclusion, Qumseya et al's study 12 adds to the mounting evidence that there is increased risk of BE after SG. Given the increasing popularity of SG as the treatment of choice for obesity, we may just be at the cusp of understanding the implications of this procedure.…”

“…10 Moreover, the increased afterload on the esophagus may trigger esophageal dysmotility, mimicking a pseudo-achalasia pattern. 11 In this issue of Gastrointestinal Endoscopy, Qumseya et al 12 set out to further assess the risk of BE after SG. The authors conducted a systematic review and meta-analysis, incorporating 10 studies and 680 patients.…”

Endoscopic Diagnosis and Treatment of Bariatric Surgery Complications

“…The postsurgical changes that may explain this relationship are the Hiss angle alteration, reduced pressure of the lower esophageal sphincter (LES), and damage to the sling fibers. 7 GERD increases the risk for Barrett's esophagus (BE), which is known as a precursor of esophageal adenocarcinoma. As obese people have a higher prevalence of GERD, it is expected that there will be an increase in the prevalence of BE in these cases.…”

“…As obese people have a higher prevalence of GERD, it is expected that there will be an increase in the prevalence of BE in these cases. 7 The rate of occurrence in the literature of GERD after SG ranges from 8.6 to 47%. Symptoms interfere with daily activities and eating habits.…”