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

Qumseya, Bashar J.; Gendy, Sherif; Wallace, Alexander; Yang, Dennis; Estores, Davis; Ayzengart, Alexander; Draganov, Peter V.

doi:10.1055/a-1145-3500

Cited by 16 publications

(13 citation statements)

References 31 publications

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“…Note that 11.6% of cases were de novo; none of the patients who had SG had BE at the screening EGD before the procedure. In our previous meta-analysis, 13 we studied more than 13,000 patients who had EGD before bariatric surgery and showed that despite their obesity, the risk of BE in this patient population was low (<1%). The above data would suggest that screening might be more useful if started around 3 years after SG.…”

Section: Discussionmentioning

confidence: 99%

“…18 The final score for studies (with a maximum score of 16) was reported, as previously described. 13 Based on this system, we rated studies as high (12)(13)(14)(15)(16); moderate (9-11); fair (7-8), and poor ( 6). We also planned to identify and remove possible outliers.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…8,12 Despite this, a meta-analysis of more than 13,000 patients who underwent esophagogastroduodenoscopy (EGD) before bariatric surgery reported a low rate of BE at less than 1%. 13 Yet, if patients have worsening GERD after SG, we hypothesize that they would have an increased risk for developing BE. Based on clinical practice guidelines, 14 patients whose expected prevalence of BE is above 10% are thought to be at high risk for BE, and screening for BE is recommended.…”

Section: Introductionmentioning

confidence: 99%

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

Qumseya

Qumsiyeh

Ponniah

et al. 2021

Gastrointestinal Endoscopy

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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.)

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Section: Discussionmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Qumseya

Qumsiyeh

Ponniah

et al. 2021

Gastrointestinal Endoscopy

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“…The initial version of the study was conceptualized based on our experience in conducting systematic reviews and meta-analyses and guideline development. [12][13][14][15][16][17][18][19][20][21][22] The pilot version was developed based on common concerns regarding study quality as encountered by physicians and raters who review such literature. The pilot tool consisted of 10 questions.…”

Section: Pilot Versionmentioning

confidence: 99%

Quality assessment for systematic reviews and meta-analyses of cohort studies

Qumseya

2021

Gastrointestinal Endoscopy

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Background and Aims: There is a growing need for valid, efficient, and easy scoring scales to rate the quality of cohort studies. We aimed to develop and validate a quality assessment score to be used for cohort studies. Methods: We followed a rigorous process to establish content, face, and construct validity. Most questions were scored at 0 or 1. Inter-rater reliability and test-retest reliability were assessed using the Spearman correlation coefficient (r s) and Cohen's k statistic. Internal consistency was measured using the Kuder-Richardson formula 20 (KR20). Results: The final tool consists of 9 questions with a maximum score of 10. The inter-rater reliability was high with the Spearman correlation coefficient (r s Z .66). Agreement for inclusion was 90%. Test-retest reliability was high. For rater 1, r s Z .91, k Z .38 for scores, and k Z 1 for inclusion. For rater 2, r Z .94, 80% agreement for scores, and 100% agreement for inclusion. Internal consistency was reasonable based on 2 studies: KR20 Z .21 and KR20 Z .65. The novel scale rated highest in efficiency, understandably, ease of use, and ease of interpretation when compared with 3 other scales. Conclusions: This novel scale has favorable performance characteristics, is efficient to conduct, and is easy to interpret and will be very helpful for physicians and researchers conducting systematic reviews and meta-analyses. (Gastrointest Endosc 2021;93:486-94.) In recent years, clinicians have come to recognize that medical practices need to be based on systematic review of all available evidence. 1 In 2011, the Institute of Medicine, now the National Academy of Medicine, defined guidelines as "recommendations intended to optimize patient care that are informed by a systematic review of evidence." (p. 25)2 This evidence-based approach has become a critical aspect of the practice of medicine. The process is transparent, based on rigorous methodology, and reproducible. Adopting evidence-based guidelines has changed the way physicians, medical societies, and guideline panels use the medical literature to make clinical decisions. 3 Performing systematic reviews and meta-analyses are key components of all medical guidelines at this point. 4 An integral part of conducting a systematic review is to rate the quality of individual articles. 5 For this purpose, many scoring systems have been developed and validated. 6,7 However, the use of such quality scores has been fraught with several shortcomings. First, a large gap remains in the area of scoring cohort studies. These include prospective or retrospective studies, which were not designed as randomized trials. Although many scoring systems exist for randomized trails, 8 only a few scores have been developed for cohort studies. 9-11 Second, previous scales can be complex to use, score, and interpret. Last, many scoring tools did little to address specific concerns relating to the process of meta-analysis. We believe the ideal quality assessment scale for cohort studies Abbreviations: BE, Barrett's esophagus; KR20,...

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“…Without treatment, 10% of people will be at risk for esophageal adenocarcinoma. 14,15 There are also contradictions and disputes in various research conclusions.…”

Section: Introductionmentioning

confidence: 99%

Study on The Symptoms and Esophageal Motility Characteristics of Gastroesophageal Reflux Disease Patients with Obesity

Yang

Rehman

Wang

et al. 2020

Preprint

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Background: Previous studies have shown that obesity affects the occurrence and development of GERD, GERD is also one of the many complications of obesity. However, few prior studies have evaluated the symptoms and esophageal motility characteristics of GERD patients with obesity. The purpose of this study was to assess the symptoms and esophageal motility characteristics of gastroesophageal reflux disease (GERD) patients with obesity and the relationship between symptoms and esophageal motility results. Methods: We conducted a retrospective study. Patients were divided into four groups according to whether diagnosed with GERD and obesity: obese GERD group (N=25), obese non-GERD group (N=21), non-obese GERD group (N=29), non-obese non-GERD group (N=22). High resolution manometry (HRM) was performed to assess esophageal motility. Gastroesophageal reflux symptoms were in accordance with the GERD questionnaire (GerdQ). Results: a) The main symptoms of obese GERD group were: reflux, upper stomach pain, nausea; in the non-obese GERD group were: reflux, heartburn and taking additional medication. b) The LES resting pressure in obese GERD group was lower than in non-obese non-GERD group, non-obese GERD group and obese non-GERD group ( P <0.05); The EGJ separation distance in obese GERD group was larger compared with non-obese non-GERD group, non-obese GERD group and obese non-GERD group ( P <0.05); The length of the esophagus in obese GERD group was shorter than in non-obese non-GERD group, non-obese GERD group and obese non-GERD group ( P <0.05); The DCI in obese GERD group was lower than in obese non-GERD group ( P <0.05). c) In obese GERD group, patients with reduced LES resting pressure or increased EGJ separation distance are more likely to have "reflux" symptoms. Conclusions: Comparing with GERD patients without obesity, the symptoms, esophageal motility, esophageal motility mechanism related to the symptoms of GERD patients with obesity got different characteristics. This result provides a reference for treatment options of GERD patients with obesity.

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

Cited by 16 publications

References 31 publications

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

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

Quality assessment for systematic reviews and meta-analyses of cohort studies

Study on The Symptoms and Esophageal Motility Characteristics of Gastroesophageal Reflux Disease Patients with Obesity

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