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A Systematic Review and Meta-Analysis of the Effect of Roux-en-Y Gastric Bypass on Barrett’s Esophagus

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Abstract

Background

Obesity is associated with a twofold risk of gastroesophageal reflux disease (GERD) and thrice the risk of Barrett’s esophagus (BE). Roux-en-Y gastric bypass (RYGB) leads to weight loss and improvement of GERD in population with obesity, but its effect on BE is less clear.

Methods

Bibliographic databases were searched systematically for relevant articles till January 31, 2019. Studies evaluating the effect of RYGB on BE with preoperative and postoperative endoscopy and biopsy were included. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool. Meta-analysis was conducted using Mantel-Haenszel, random effects model and presented as risk difference (RD) or odds ratio (OR) with 95% confidence intervals.

Results

Eight studies with 10,779 patients undergoing RYGB reported on 117 patients with BE with follow-up of > 1 year. Significant regression of BE after RYGB was observed (RD − 0.56.95% c.i. − 0.69 to − 0.43; P < 0.001). Subgroup analysis showed regression of both short-segment BE [ssBE] (RD − 0.51.95% c.i. − 0.68 to − 0.33; P < 0.001) and long-segment BE [lsBE] (RD − 0.46.95% c.i. − 0.71 to − 0.21; P < 0.001). RYGB also caused improvement in GERD in patients of BE (RD − 0.93, 95% c.i. − 1.04 to − 0.81; P < 0.001). RYGB was strongly associated with regression of BE compared with progression (OR 31.2.95% c.i. 11.37 to 85.63; P < 0.001).

Conclusions

RYGB leads to significant improvement of BE at > 1 year after surgery in terms of regression and resolution of the associated GERD. Both ssBE and lsBE improve after RYGB significantly.

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Acknowledgments

M.T.A is grateful to the research committee members of Obesity Service, Luton and Dunstable University Hospital, UK, for the support he received to carry out this research, including acceptance of the study protocol and analysis plan.

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Authors and Affiliations

  1. Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, United Kingdom

    Md Tanveer Adil, Omer Al-taan, Farhan Rashid, Aruna Munasinghe, Vigyan Jain, Douglas Whitelaw & Periyathambi Jambulingam

  2. Department of General Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP, United Kingdom

    Kamal Mahawar

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  1. Md Tanveer Adil
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Contributions

K.M suggested the importance of carrying out this research. M.T.A and K.M. conducted the literature search and were involved in the selection of studies. M.T.A, K.M, F.R, and V.J were involved in extraction of data. M.T.A, O.A, and A.M were involved in data analysis and interpretation. M.T.A, P.J, and D.W performed the assessment of risk of bias in the included studies. All authors contributed to the write-up, corrections, validation, and final approval of the manuscript.

Corresponding author

Correspondence to Md Tanveer Adil.

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The study protocol was approved by the research committee of Obesity Service, Luton and Dunstable University Hospital, including research methodology and analysis plan detailed in the manuscript.

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The authors declare that they have no competing interests in relation to this manuscript.

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Adil, M.T., Al-taan, O., Rashid, F. et al. A Systematic Review and Meta-Analysis of the Effect of Roux-en-Y Gastric Bypass on Barrett’s Esophagus. OBES SURG 29, 3712–3721 (2019). https://doi.org/10.1007/s11695-019-04083-0

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