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Barrett`s Esophagus in Bariatric Surgery: Regression or Progression?

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Abstract

Introduction

Morbid obesity is well known as a risk factor for gastroesophageal reflux disease (GERD) and its related disorders such as Barrett’s esophagus (BE). This study aimed to evaluate the development of BE in patients who underwent bariatric surgery.

Materials and Methods

Using a single-center prospectively established database of obese patients who underwent bariatric surgery from 01/2012 to 12/2019, we retrospectively compared the preoperative endoscopic findings of BE to those after 1–2 years and 3–5 years following bariatric surgery. The change of BE was detected endoscopically according to Prague classification and histologically according to the British guidelines of detecting columnar epithelium on the distal esophagus.

Results

Among 914 obese patients who underwent bariatric surgery and received a preoperative esophagogastroduodenoscopy (EGD), we found 119 patients (13%) with BE. A follow-up EGD was performed in 74 of the BE patients (62.2%). A total of 37 (50%) patients underwent a follow-up EGD after 1–2 years and 45 (60.8%) patients underwent it after 3–5 years. Among many clinical parameters, the surgical procedure was the only significant factor for the change of BE after bariatric surgery (p < 0.05). A regression of BE was found in 19 patients (n = 54, 35%) after laparoscopic Roux-en-Y- gastric bypass (LRYGB). Furthermore, a progression of BE was detected in six patients (n = 20, 30%) after laparoscopic sleeve gastrectomy (LSG).

Conclusion

RYGB should be considered in obese patients with BE. Detecting BE prior to bariatric surgery may have an impact on decision-making regarding the suitable surgical bariatric procedure.

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Data Availability

Study Data are available by the corresponding author.

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Author information

Author notes

  1. Yusef Moulla and Haitham Hamadeh contributed equally to this work.

  2. Undine-Gabriele Lange and Arne Dietrich contributed equally to this work.

Authors and Affiliations

  1. Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103, Leipzig, Germany

    Yusef Moulla, Lena Seidemann, Matthias Mehdorn, Ines Gockel, Undine-Gabriele Lange & Arne Dietrich

  2. Department of Visceral, Thoracic and Vascular Surgery, St. Johann Nepomuk Hospital of Erfurt, Liebigstr. 20, 99097, Erfurt, Germany

    Haitham Hamadeh

  3. Department of Endocrinology, Nephrology, Rheumatology, University Hospital of Leipzig, 04103, Leipzig, Germany

    Mathias Blüher

  4. Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Centrum München at the University of Munich and University Hospital Leipzig, 04103, Leipzig, Germany

    Mathias Blüher

  5. Department of Oncology, Gastroenterology, Hepatology and Pneumology, University Hospital of Leipzig, 04103, Leipzig, Germany

    Jürgen Feisthammel & Albrecht Hoffmeister

Authors
  1. Yusef Moulla
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  2. Haitham Hamadeh
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Correspondence to Yusef Moulla.

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Key points

Preoperative EGD has a significant impact on the choice of bariatric procedure.

RYGB is recommended in obese patients with BE.

Structured surveillance with EGD after LSG should be considered in patients with BE.

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Moulla, Y., Hamadeh, H., Seidemann, L. et al. Barrett`s Esophagus in Bariatric Surgery: Regression or Progression?. OBES SURG 33, 3391–3401 (2023). https://doi.org/10.1007/s11695-023-06829-3

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  • DOI: https://doi.org/10.1007/s11695-023-06829-3

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