No increase in prevalence of Barrett's oesophagus in a surgical series of obese patients referred for laparoscopic gastric banding

Masci, E.; Viaggi, P.; Mangiavillano, Benedetto; Pietro, Salvatore Di; Micheletto, Giancarlo; Prisco, F; Paganelli, Michele; Pontiroli, Ettore Antonio; Laneri, Marco; Testoni, Sabrina Gloria Giulia; Testoni, Pier Alberto

doi:10.1016/j.dld.2011.02.001

Cited by 11 publications

(4 citation statements)

References 28 publications

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“…Of the 13 434 patients who underwent preoperative endoscopy, only 114 cases of BE were reported. Seven of the studies reported a zero prevalence of BE [22,25,27,35,46,49,50]. The diagnosis of BE was not confirmed on biopsy in 11 of the 29 studies [24,26,28,29,34,37,40,42,43,45,48].…”

Section: Prevalence Of Bementioning

confidence: 97%

Prevalence of Barrett’s esophagus in obese patients undergoing pre-bariatric surgery evaluation: a systematic review and meta-analysis

et al. 2020

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Introduction Obesity is a known risk factor for gastroesophageal reflux disease (GERD), Barrett’s esophagus (BE), and esophageal adenocarcinoma (EAC). Obese patients routinely undergo preoperative esophagogastroduodenoscopy (EGD) before bariatric procedures. We aimed to assess the prevalence of BE in this patient population. Methods We conducted a comprehensive literature search ending in March 2019. Search results were imported into covidence.org and screened by two independent reviewers. Heterogeneity was assessed using I 2 and Q statistics and publication bias using funnel plots and the Orwin fail-safe test. Random-effects modeling was used in all analyses. Results Of 4087 citations, 77 were reviewed in full text and 29 were included in the final analysis based on our predetermined inclusion/exclusion criteria. A total of 13 434 patients underwent pre-bariatric surgery EGD. The pooled prevalence of BE using random-effects modeling was 0.9 % (95 % confidence interval [CI] 0.7 % – 1.3 %); P < 0.001; I 2 = 58 %, Q = 67). In meta-regression analyses, controlling for sex and GERD, we found a positive association between mean body mass index (BMI) and the prevalence of BE (β = 0.15 [95 %CI 0.02 – 0.28]; P = 0.03). A linear relationship between the prevalence of BE and the prevalence of GERD was also noted (β = 3.9 [95 %CI 0.4 – 7.5]; P = 0.03). Conclusions Obesity has been postulated as a major risk factor for BE, yet we found that the prevalence of BE in morbidly obese patients undergoing preoperative EGD was very low. Therefore, obesity alone may not be a major risk factor for BE.

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Section: Prevalence Of Bementioning

confidence: 97%

Prevalence of Barrett’s esophagus in obese patients undergoing pre-bariatric surgery evaluation: a systematic review and meta-analysis

et al. 2020

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“…Inconsistent findings have been found regarding association of BMI with BO, some studies finding no association [Gerson et al 2007; Corley et al 2007a; Masci et al 2011], some finding an association only in women [Jacobson et al 2009; Steevens et al 2001], and some finding a positive association [Stein et al 2005; Smith et al 2005; Bu et al 2006; Anderson et al 2007]. A meta-analysis found that BMI is not associated with BO [Cook et al 2008] and instead it is WC that confers a twofold risk for BO [Kramer et al 2013].…”

Section: Introductionmentioning

confidence: 99%

The role of obesity in oesophageal cancer development

Long

Beales

2014

Therap Adv Gastroenterol

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Abstract:The incidence of oesophageal adenocarcinoma has increased dramatically in the developed world in the last half century. Over approximately the same period there has been an increase in the prevalence of obesity. Multiple epidemiological studies and metaanalyses have confirmed that obesity, especially abdominal, visceral obesity, is a risk factor for gastro-oesophageal reflux, Barrett's oesophagus and oesophageal adenocarcinoma. Although visceral obesity enhances gastro-oesophageal reflux, the available data also show that visceral obesity increases the risk of Barrett's oesophagus and adenocarcinoma via reflux-independent mechanisms. Several possible mechanisms could link obesity with the risk of oesophageal adenocarcinoma in addition to mechanical effects increasing reflux. These include reduced gastric Helicobacter pylori infection, altered intestinal microbiome, factors related to lifestyle, the metabolic syndrome and associated low-grade inflammation induced by obesity and the secretion of mediators by adipocytes which may directly influence the oesophageal epithelium. Of these adipocyte-derived mediators, increased leptin levels have been independently associated with progression to oesophageal adenocarcinoma and in laboratory studies leptin enhances malignant behaviours in cell lines. Adiponectin is also secreted by adipocytes and levels decline with obesity: decreased serum adiponectin levels are associated with malignant progression in Barrett's oesophagus and experimentally adiponectin exerts anticancer effects in Barrett's cell lines and inhibits growth factor signalling. At present there are no proven chemopreventative interventions that may reduce the incidence of obesity-associated oesophageal cancer: observational studies suggest that the combined use of a statin and aspirin or another cyclo-oxygenase inhibitor is associated with a significantly reduced cancer incidence in patients with Barrett's oesophagus.

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“…11 During routine endoscopy of morbidly obese patients for bariatric surgery, the incidence of Barrett's esophagus has been reported in the range of 1.2% to 3.7%. 12–15 However, in more than 1000 patients referred for gastric banding, no cases of Barrett's esophagus were found on routine endoscopy by Masci et al 16 though esophagitis and hiatal hernia were found in about 8% and 12% of the cases respectively. 16 After excluding patients who reported GERD symptoms and those who were on therapy for GERD symptoms, women undergoing routine upper endoscopy before bariatric surgery were found to have Barrett's esophagus in 8% of the cases.…”

Section: Methodsmentioning

confidence: 99%