Patients Having Bariatric Surgery: Surgical Options in Morbidly Obese Patients with Barrett’s Esophagus

Abstract

This article summarizes the currently knowledge and results observed in patients with obesity and Barrett's esophagus which were presented and discussed during the IFSO 2014 held in Montreal. In this meeting, the surgical options for the management after bariatric surgery were discussed. For this purpose, a complete revision of the available literature was done including Pubmed, Medline, Scielo database, own experience, and experts opinion. A total of 49 publications were reviewed and included in the present paper. The majority of authors agree that gastric bypass is the procedure of choice. Sleeve gastrectomy is not an absolute contraindication. Up to now, gastric bypass appears to be the best procedure for treatment of obese patients with Barrett's esophagus. Future investigations should give the definitive consensus.

Roux-en-Y Gastric Bypass as a Treatment for Barrett’s Esophagus after Sleeve Gastrectomy

“…In their review article, Kindel and Oleynikov [28] recommended RYGB for patients with BE based on its superiority in reflux control (acid and non-acid events) compared with other bariatric procedures. Braghetto and Csendes come to a similar conclusion, being that RYGB is the procedure of choice for BE patients [29].…”

Bulimia nervosa in obese patients qualified for bariatric surgery - clinical picture, background and treatment.

“…Considering the fact that gastric juice irritates the esophageal mucosa due to gastroesophageal reflux (which accompanies both obesity and bulimia nervosa) or inducing vomiting (in the course of compensatory behaviors), it is usually recommended to perform gastrointestinal bypass procedures in this group of patients. Such a procedure is recommended by the majority of specialists in the group of patients with gastroesophageal reflux disease [32, 48–50], especially a severe form, mainly in patients with Barrett’s esophagus [32, 48, 49, 51, 52]. Although sleeve gastrectomy is a popular procedure, resulting in significant body weight loss due to a restrictive mechanism (limited gastric volume) and a hormonal mechanism (reduced ghrelin production), it is generally not recommended in such cases because gastric juice has a higher pH compared to RYGB and factors such as reduced pressure of the lower esophageal sphincter increase the tendency for gastroesophageal reflux disease [51].…”

“…Although sleeve gastrectomy is a popular procedure, resulting in significant body weight loss due to a restrictive mechanism (limited gastric volume) and a hormonal mechanism (reduced ghrelin production), it is generally not recommended in such cases because gastric juice has a higher pH compared to RYGB and factors such as reduced pressure of the lower esophageal sphincter increase the tendency for gastroesophageal reflux disease [51]. According to Braghetto and Csendes [48, 49], Barrett’s esophagus may be a late complication of this procedure. Therefore, this procedure should be avoided in patients from the risk group, including those with bulimia nervosa.…”

Consecuencias clínicas posgastrectomía vertical tubular: enfermedad por reflujo gastroesofágico

“…Tai 14 publicó una prevalencia de esofagitis erosiva de 16,7 a 66,7%, asociado con una mayor gravedad de los síntomas de ERGE relacionados con la presencia de una hernia hiatal después de la operación (27%). En una publicación anterior 42 , encontramos esofagitis en 15,5% y se detectó esófago de Barrett en 1,2% a los 3 años de seguimiento. En la actualidad, a los 5-9 años de seguimiento, el esófago de Barrett aumenta a 4,8%.…”