Skip to main content

Advertisement

SpringerLink
Log in

Systematic Endoscopy 5 Years After Sleeve Gastrectomy Results in a High Rate of Barrett’s Esophagus: Results of a Multicenter Study

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Recent evidence has indicated an increased risk of Barrett’s esophagus (BE) in the long term after sleeve gastrectomy (SG).

Aim

The aim of the study is to investigate the spectrum of gastroesophageal reflux disease (GERD) symptoms as well as the prevalence of BE, at minimum 5 years after SG in patients who underwent SG in different bariatric centers of two countries: France and Italy.

Patients and Methods

Five high volume outpatient centers dedicated to bariatric surgery that routinely perform upper GI endoscopy before any bariatric procedures were invited to participate in the study. From January 2017 to June 2018, each center during scheduled postoperative evaluation after surgery asked a minimum 10 consecutive patients, which had performed SG at least 5 years before and with no evidence of BE preoperatively, to undergo another upper GI endoscopy.

Results

Ninety (66 F) consecutive patients were enrolled. The mean follow-up was 78 ± 15 months, and the mean total body weight loss was 25 ± 12%. The prevalence of BE was 18.8% with no significant difference among centers. Weight loss failure was significantly associated with BE (p < 0.01). The prevalence of GERD symptoms, erosive esophagitis, and the usage of PPIs increased from 22%, 10%, and 22% before the SG to 76%, 41%, and 52% at the time of follow-up, respectively (p < 0.05).

Conclusions

This multicenter study show a high rate of BE at least 5 years after SG. Weight loss failure was significantly associated with BE. We suggest to provide systematic endoscopy in these patients to rule out this condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28:3783–94. https://doi.org/10.1007/s11695-018-3.

    Article  PubMed  Google Scholar 

  2. Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA. 2018;319(3):255–65.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Angrisani L. 2014: the year of the sleeve supremacy. Obes Surg. 2017;27(6):1626–7.

    Article  PubMed  Google Scholar 

  4. Stenard F, Iannelli A. Laparoscopic sleeve gastrectomy and gastroesophageal reflux. World J Gastroenterol. 2015;21(36):10348–57.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Iannelli A, Sans A, Martini F, et al. Hiatal hernia, GERD, and sleeve gastrectomy: a complex interplay. Obes Surg. 2016;26(10):2485–7.

    Article  PubMed  Google Scholar 

  6. Oor JE, Roks DJ, Ünlü Ç, et al. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg. 2016;211(1):250–67.

    Article  PubMed  Google Scholar 

  7. Hendricks L, Alvarenga E, Dhanabalsamy N, et al. Impact of sleeve gastrectomy on gastroesophageal reflux disease in a morbidly obese population undergoing bariatric surgery. Surg Obes Relat Dis. 2016;12(3):511–7.

    Article  PubMed  Google Scholar 

  8. Eisen GM, Sandler RS, Murray S, et al. The relationship between gastroesophageal reflux disease and its complications with Barrett’s esophagus. Am J Gastroenterol. 1997;92(1):27–31.

    CAS  PubMed  Google Scholar 

  9. Drahos J, Li L, Jick SS, et al. Metabolic syndrome in relation to Barrett’s esophagus and esophageal adenocarcinoma: results from a large population-based case-control study in the Clinical Practice Research Datalink. Cancer Epidemiol. 2016;42:9–14.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis. 2017;13(4):568–74.

    Article  PubMed  Google Scholar 

  11. Felsenreich DM, Kefurt R, Schermann M, et al. Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg. 2017;27(12):3092–101.

    Article  PubMed  Google Scholar 

  12. Ronkainen J, Aro P, Storskrubb T, et al. Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology. 2005;129(6):1825–31.

    Article  PubMed  Google Scholar 

  13. Spechler SJ, Souza RF. Barrett’s esophagus. N Engl J Med. 2014;371(9):836–45.

    Article  CAS  PubMed  Google Scholar 

  14. Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology. 2006;131(5):1392–9.

    Article  PubMed  Google Scholar 

  15. Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2017;49(2):191–8.

    Article  PubMed  Google Scholar 

  16. Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20.

    Article  PubMed  Google Scholar 

  17. Ronkainen J, Aro P, Storskrubb T, et al. High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: a Kalixanda study report. Scand J Gastroenterol. 2005;40(3):275–85.

    Article  PubMed  Google Scholar 

  18. Sharma A, Aggarwal S, Ahuja V, et al. Evaluation of gastroesophageal reflux before and after sleeve gastrectomy using symptom scoring, scintigraphy, and endoscopy. Surg Obes Relat Dis. 2014;10(4):600–5.

    Article  PubMed  Google Scholar 

  19. Rebecchi F, Allaix ME, Giaccone C, et al. Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation. Ann Surg. 2014;260(5):909–14.

    Article  PubMed  Google Scholar 

  20. Iannelli A, Martini F, Schneck AS, et al. Twisted gastric sleeve. Surgery. 2015;157(1):163–5.

    Article  PubMed  Google Scholar 

  21. Lazoura O, Zacharoulis D, Triantafyllidis G, et al. Symptoms of gastroesophageal reflux following laparoscopic sleeve gastrectomy are related to the final shape of the sleeve as depicted by radiology. Obes Surg. 2011;21(3):295–9.

    Article  PubMed  Google Scholar 

  22. Melissas J, Braghetto I, Molina JC, et al. Gastroesophageal reflux disease and sleeve gastrectomy. Obes Surg. 2015;25(12):2430–5.

    Article  PubMed  Google Scholar 

  23. Soricelli E, Casella G, Baglio G, et al. Lack of correlation between gastroesophageal reflux disease symptoms and esophageal lesions after sleeve gastrectomy. Surg Obes Relat Dis. 2018;14(6):751–6.

    Article  PubMed  Google Scholar 

  24. Steevens J, Schouten LJ, Driessen ALC, et al. A prospective cohort study on overweight, smoking, alcohol consumption, and risk of Barrett’s esophagus. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2011;20(2):345–58.

    Article  Google Scholar 

  25. Gatenby P, Ramus J, Caygill C, et al. Routinely diagnosed low-grade dysplasia in Barrett’s oesophagus: a population-based study of natural history. Histopathology. 2009;54(7):814–9.

    Article  PubMed  Google Scholar 

  26. Rastogi A, Puli S, El-Serag HB, et al. Incidence of esophageal adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia: a meta-analysis. Gastrointest Endosc. 2008;67(3):394–8.

    Article  PubMed  Google Scholar 

  27. Angrisani L, Santonicola A, Hasani A, et al. Five-year results of laparoscopic sleeve gastrectomy: effects on gastroesophageal reflux disease symptoms and co-morbidities. Surg Obes Relat Dis. 2016;12(5):960–8.

    Article  PubMed  Google Scholar 

  28. Wright FG, Duro A, Medici JR, et al. D. Esophageal adenocarcinoma five years after laparoscopic sleeve gastrectomy. A case report. Int J Surg Case Rep. 2017;32:47–50.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Gagner M. Is sleeve gastrectomy always an absolute contraindication in patients with Barrett’s? Obes Surg. 2016;26(4):715–7.

    Article  PubMed  Google Scholar 

  30. Lagergren J, Mattsson F, Nyrén O. Gastroesophageal reflux does not alter effects of body mass index on risk of esophageal adenocarcinoma. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2014;12(1):45–51.

    Google Scholar 

  31. Gagner M, Braghetto I. A symposium on management of Barrett’s in patients having bariatric surgery. Obes Surg. 2016;26(4):709.

    Article  CAS  PubMed  Google Scholar 

  32. Frezza EE, Ikramuddin S, Gourash W, et al. Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2002;16(7):1027–31.

    Article  CAS  PubMed  Google Scholar 

  33. Braghetto I, Csendes A. Patients having bariatric surgery: surgical options in morbidly obese patients with Barrett’s esophagus. Obes Surg. 2016;26(7):1622–6.

    Article  CAS  PubMed  Google Scholar 

  34. Parikh K, Khaitan L. Radiofrequency ablation coupled with Roux-en-Y gastric bypass: a treatment option for morbidly obese patients with Barrett’s esophagus. J Surg Case Rep. 2016;2016 (3).

Download references

Author information

Authors and Affiliations

  1. Université Côte d’Azur, Nice, France

    Lionel Sebastianelli, Marine Benois, Geoffroy Vanbiervliet, Laurent Bailly, Thierry Piche & Antonio Iannelli

  2. Centre Hospitalier Universitaire de Nice, Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France

    Lionel Sebastianelli, Marine Benois, Geoffroy Vanbiervliet, Thierry Piche & Antonio Iannelli

  3. Centre Hospitalier Universitaire de Nice, Département de Santé Publique, Nice, France

    Laurent Bailly

  4. Department of Digestive Surgery, Center of Bariatric Surgery, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France

    Maud Robert

  5. Department of Digestive Surgery, Center of Bariatric Surgery, Hospital Saint-Joseph, Marseille, France

    Nicolas Turrin & Emmanuel Gizard

  6. Week Surgery, Bariatric Unit, Padova University Hospital, Padova, Italy

    Mirto Foletto, Marco Bisello & Alice Albanese

  7. Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, 84081, Salerno, Italy

    Antonella Santonicola & Paola Iovino

  8. General and Endoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy

    Luigi Angrisani

  9. Inserm U1091—CNRS UMR7277—Institut de Biologie Valrose—Université Nice Sophia Antipolis, Nice, France

    Laurent Turchi

  10. IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic of Campania “Luigi Vanvitelli”, Naples, Italy

    Luigi Schiavo

  11. Inserm, U1065, Team 8 “Hepatic Complications of Obesity”, Nice, France

    Antonio Iannelli

Authors
  1. Lionel Sebastianelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marine Benois
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Geoffroy Vanbiervliet
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laurent Bailly
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maud Robert
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nicolas Turrin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emmanuel Gizard
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mirto Foletto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Marco Bisello
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alice Albanese
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Antonella Santonicola
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Paola Iovino
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Thierry Piche
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Luigi Angrisani
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Laurent Turchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Luigi Schiavo
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Antonio Iannelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Iannelli.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Written informed consent was obtained for each individual participant included in the study.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sebastianelli, L., Benois, M., Vanbiervliet, G. et al. Systematic Endoscopy 5 Years After Sleeve Gastrectomy Results in a High Rate of Barrett’s Esophagus: Results of a Multicenter Study. OBES SURG 29, 1462–1469 (2019). https://doi.org/10.1007/s11695-019-03704-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-019-03704-y

Keywords

Search

Navigation