Advertisement

Obesity Surgery

, Volume 22, Issue 5, pp 764–772 | Cite as

Laparoscopic Treatment of Obese Patients with Gastroesophageal Reflux Disease and Barrett’s Esophagus: a Prospective Study

  • Italo BraghettoEmail author
  • Owen Korn
  • Attila Csendes
  • Luis Gutiérrez
  • Héctor Valladares
  • Max Chacon
Clinical Research

Abstract

Background

Short-segment Barrett’s esophagus (SSBE) or long-segment Barrett’s esophagus (LSBE) is the consequence of chronic gastroesophageal reflux disease (GERD), which is frequently associated with obesity. Obesity is a significant risk factor for the development of GERD symptoms, erosive esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma. Morbidly obese patients who submitted to gastric bypass have an incidence of GERD as high as 50% to 100% and Barrett’s esophagus reaches up to 9% of patients.

Methods

In this prospective study, we evaluate the postoperative results after three different procedures—calibrated fundoplication + posterior gastropexy (CFPG), fundoplication + vagotomy + distal gastrectomy + Roux-en-Y gastrojejunostomy (FVDGRYGJ), and laparoscopic resectional Roux-en-Y gastric bypass (LRRYGBP)—among obese patients.

Results

In patients with SSBE who submitted to CFPG, the persistence of reflux symptoms and endoscopic erosive esophagitis was observed in 15% and 20.2% of them, respectively. Patients with LSBE were submitted to FVDGRYGJ or LRRYGBP which significantly improved their symptoms and erosive esophagitis. No modifications of LESP were observed in patients who submitted to LRRYGBP before or after the operation. Acid reflux diminished after the three types of surgery were employed. Patients who submitted to LRRYGBP presented a significant reduction of BMI from 41.5 ± 4.3 to 25.7 ± 1.3 kg/m2 after 12 months.

Conclusions

Among patients with LSBE, FVDGRYGJ presents very good results in terms of improving GERD and Barrett’s esophagus, but the reduction of weight is limited. LRRYGBP improves GERD disease and Barrett’s esophagus with proven reduction in body weight and BMI, thus becoming the procedure of choice for obese patients.

Keywords

Barrett’s esophagus Obese patients Laparoscopy Fundoplication Gastric bypass 

Notes

Conflicts of Interest

All contributing authors declare that they have no conflicts of interest.

References

  1. 1.
    Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143:199–211.PubMedGoogle Scholar
  2. 2.
    Csendes A, Burdiles P, Rojas J, et al. Pathological gastroesophageal reflux in patients with severe, morbid and hyper obesity. Rev Med Chil. 2001;129:1038–43.PubMedGoogle Scholar
  3. 3.
    Varela JE, Hinojosa MW, Nguyen NT. Laparoscopic fundoplication compared with laparoscopic gastric bypass in morbidly obese patients with gastroesophageal reflux disease. Surg Obes Relat Dis. 2009;5:139–43.PubMedCrossRefGoogle Scholar
  4. 4.
    Kemdrich ML, Houghton SG. Gastroesophageal reflux disease in obese patients: the role of obesity in management. Dis Esophagus. 2006;19:57–63.CrossRefGoogle Scholar
  5. 5.
    Gómez Escudero O, Herrera Hernández MF, Valdovinos Díaz MA. Obesity and gastroesophageal reflux disease. Rev Invest Clin. 2002;54:320–7.PubMedGoogle Scholar
  6. 6.
    Csendes A, Alvarez F, Medina E, et al. Prevalence of digestive symptoms in normal adult women and it association with biliary lithiasis. Rev Med Chil. 1994;122:531–6.Google Scholar
  7. 7.
    Sise A, Friedenberg FK. A comprehensive review of gastroesophageal reflux disease and obesity. Obes Rev. 2008;9:194–203.PubMedCrossRefGoogle Scholar
  8. 8.
    Friedenberg FK, Xanthopoulos M, Foster GD, et al. The association between gastroesophageal reflux disease and obesity. Am J Gastroenterol. 2008;103:2111–22.PubMedCrossRefGoogle Scholar
  9. 9.
    Csendes A. Roux-en-Y after gastric bypass. Arch Surg. 2008;143:808.PubMedGoogle Scholar
  10. 10.
    Csendes A, Braghetto I, Burdiles P, et al. Late results of the surgical treatment of 125 patients with short-segment Barrett’s esophagus. Arch Surg. 2009;144:921–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Oelschlager BK, Pellegrini CA. Laparoscopic treatment of Barrett's esophagus. Adv Surg. 2004;38:1–12.PubMedGoogle Scholar
  12. 12.
    Csendes A, Burdiles P, Braghetto I, et al. Dysplasia and adenocarcinoma after classic antireflux surgery in patients with Barrett’s esophagus. The need for long term subjective and objective follow-up. Ann Surg. 2002;235:178–1285.PubMedCrossRefGoogle Scholar
  13. 13.
    Biertho L, Dallemagne B, Dewandre JM, et al. Laparoscopic treatment of Barrett's esophagus: long-term results. Surg Endosc. 2007;21:11–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Zaninotto G, Cassaro M, Pennelli G, et al. Barrett's epithelium after antireflux surgery. J Gastrointest Surg. 2005;9:1253–60. discussion 1260–1.PubMedCrossRefGoogle Scholar
  15. 15.
    Jamieson GG, France M, Watson DI. Results of laparoscopic antireflux operations in patients who have Barrett's esophagus. Chest Surg Clin N Am. 2002;12:149–55.PubMedCrossRefGoogle Scholar
  16. 16.
    Csendes A, Braghetto I, Burdiles P, et al. Roux-en-Y long limb diversion as the first option for patients who have Barrett's esophagus. Chest Surg Clin N Am. 2002;12:157–84 (review).PubMedCrossRefGoogle Scholar
  17. 17.
    Csendes A. Surgical treatment of Barrett's esophagus: 1980–2003. World J Surg. 2004;28:225–31.PubMedCrossRefGoogle Scholar
  18. 18.
    Csendes A, Burdiles P, Braghetto I, et al. Early and late results of the acid suppression and duodenal diversion operation in patients with Barrett's esophagus: analysis of 210 cases. World J Surg. 2002;26:566–76.PubMedCrossRefGoogle Scholar
  19. 19.
    Merroche M, Sabaté JM, Jouer P, et al. Gastroesophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;7:894–900.CrossRefGoogle Scholar
  20. 20.
    Nelson LG, Gonzalez R, Haines K, et al. Amelioration of gastroesophageal reflux symptoms following Roux- en Y gastric bypass for clinically significant obesity. Am Surg. 2005;11:950–3.Google Scholar
  21. 21.
    Frezza EE, Ikramuddin S, Gourasch W, et al. Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en Y gastric bypass. Surg Endosc. 2002;7:1027–31.CrossRefGoogle Scholar
  22. 22.
    Braghetto I, Korn O, Debandi A, et al. Laparoscopic cardial calibration and gastropexy for treatment of patients with reflux esophagitis: pathophysiological basis and results. World J Surg. 2005;29:636–44.PubMedCrossRefGoogle Scholar
  23. 23.
    Braghetto I, Csendes A, Korn O, et al. Laparoscopic resectional gastric bypass in patients with morbid obesity: experience on 112 consecutive patients. J Gastrointest Surg. 2011;15:71–80.PubMedCrossRefGoogle Scholar
  24. 24.
    Ortiz V, Ponce M, Fernández A, et al. Value of heartburn for diagnosing gastroesophageal reflux disease in severly obese patients. Obesity. 2006;4:696–700.CrossRefGoogle Scholar
  25. 25.
    Korn O, Puentes J, Sagastume H, et al. Gastroesophageal reflux and obesity. Rev Med Chil. 1997;125:671–5.PubMedGoogle Scholar
  26. 26.
    Wu JC, Mui LM, Cheung CM, et al. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology. 2007;132:883–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Di Francesco V, Baggio E, Mastromauro M, et al. Obesity and gastro-esophageal acid reflux: physiopathological mechanisms and role of gastric bariatric surgery. Obes Surg. 2004;14:1095–102.PubMedCrossRefGoogle Scholar
  28. 28.
    Herbella FA, Sweet MP, Tedesco P, et al. Gastroesophageal reflux disease and obesity: pathophysiology and implications for treatment. J Gastrointest Surg. 2007;11:286–90.PubMedCrossRefGoogle Scholar
  29. 29.
    Hong D, Khajanchee YS, Pereira N, et al. Manometric abnormalities and gastroesophageal reflux disease in the morbidly obese. Obes Surg. 2004;14(6):744–9.PubMedCrossRefGoogle Scholar
  30. 30.
    De Groote NL, Burgerhart JS, Van de Meeberg PC, et al. Systematic review: the effects of conservative and surgical treatment for obesity on gastroesophageal reflux disease. Aliment Pharmacol Ther. 2009;30:1091–102.CrossRefGoogle Scholar
  31. 31.
    Csendes A, Braghetto I, Burdiles P. Long term results of classic antireflux surgery in 152 patients with Barrett’s esdophagus. Clinical, radiologic, endoscopic, maniometric and acid reflux test, analysis before and after operation. Surgery. 1998;123:645–57.PubMedCrossRefGoogle Scholar
  32. 32.
    Granderath FA, Kamolz T, Schweiger UM, et al. Long term follow up after laparoscopic refundoplication for failed antireflux surgery: quality of life, symptomatic outcome and patients satisfaction. J Gastrointestinal Surg. 2002;6:812–8.CrossRefGoogle Scholar
  33. 33.
    Oelschlager BK, Barreca M, Chang L, et al. Clinical and pathologic response of Barrett's esophagus to laparoscopic antireflux surgery. Ann Surg. 2003;238:458–64. discussion 464–6.PubMedGoogle Scholar
  34. 34.
    Desai KM, Soper NJ, Frisella MM, et al. Efficacy of laparoscopic antireflux surgery in patients with Barrett's esophagus. Am J Surg. 2003;186:652–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Horgan S, Pohl D, Bogetti D, et al. Failed antireflux surgery: what have we learned from reoperations? Arch Surg. 1999;134:809–15. discussion 815–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Farrell TM, Smith CD, Metreveli RE, et al. Fundoplication provides effective and durable symptom relief in patients with Barrett's esophagus. Am J Surg. 1999;178:18–21.PubMedCrossRefGoogle Scholar
  37. 37.
    Braghetto I, Csendes A, Smok G, et al. Histological inflammatory changes after surgery at the epithelium of the distal esophagus in patients with Barrett's esophagus: a comparison of two surgical procedures. Dis Esophagus. 2004;17:235–42.PubMedCrossRefGoogle Scholar
  38. 38.
    Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001;15:986–89.PubMedCrossRefGoogle Scholar
  39. 39.
    Fraser J, Watson DI, O’Boyle CJ, et al. Obesity and its effect on outcome of laparoscopic Nissen fundoplication. Dis Esoph. 2001;14:50–3.CrossRefGoogle Scholar
  40. 40.
    Csendes A, Smok G, Burdiles P, et al. Effect of duodenal diversion on low-grade dysplasia in patients with Barrett's esophagus: analysis of 37 patients. J Gastrointest Surg. 2002;6:645–52.PubMedCrossRefGoogle Scholar
  41. 41.
    Csendes A, Braghetto I, Burdiles P, et al. Regression of intestinal metaplasia to cardiac or fundic mucosa in patients with Barrett's esophagus submitted to vagotomy, partial gastrectomy and duodenal diversion. A prospective study of 78 patients with more than 5 years of follow up. Surgery. 2006;139:46–53.PubMedCrossRefGoogle Scholar
  42. 42.
    Csendes A, Burgos AM, Smok G, et al. Effect of gastric bypass on Barrett’s esophagus and intestinal metaplasia of the cardia in patients with morbid obesity. J Gastrointestinal Surg. 2006;10:259–64.CrossRefGoogle Scholar
  43. 43.
    Csendes JA, Burgos LAM, Smok SG, et al. Effects of gastric bypass on erosive esophagitis in obese subjects. Rev Med Chil. 2006;134:285–90.Google Scholar
  44. 44.
    Braghetto I, Csendes A, Burdiles P, et al. Results of surgical treatment for recurrent postoperative gastroesophageal reflux. Dis Esophagus. 2002;15:315–22.PubMedCrossRefGoogle Scholar
  45. 45.
    Schauer P, Hamad G, Ikramuddin S. Surgical management of gastroesophageal reflux disease in obese patients. Semin Laparosc Surg. 2001;8:256–64.PubMedCrossRefGoogle Scholar
  46. 46.
    Varela JE. Barrett’s esophagus: a late complication of laparoscopic adjustable gastric banding. Obes Surg. 2010;20:244–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Ortega J, Escudero MD, Mora F, et al. Outcome of esophageal function and 24-h esophageal pH monitoring after vertical banded gastroplasty and Roux-en-Y gastric bypass. Obes Surg. 2004;14:1086–94.PubMedCrossRefGoogle Scholar
  48. 48.
    Cobey F, Oeschlager B. Complete regression of Barrett’s esophagus after Roux en-Y gastric bypass. Obesity Surg. 2005;15:710–2.CrossRefGoogle Scholar
  49. 49.
    Mejía-Rivas MA, Herrera-López A, Hernández-Calleros J, et al. Gastroesophageal reflux disease in morbid obesity: the effect of Roux-en-Y gastric bypass. Obes Surg. 2008;18:1211–12.CrossRefGoogle Scholar
  50. 50.
    Zainabadi K, Courcoulas A, Awais O, et al. Laparoscopic revisión of Nissen fundoplication to Roux-en-Y gastric bypass in morbidly obese patients. Surg Endosc. 2008;22:2737–40.PubMedCrossRefGoogle Scholar
  51. 51.
    Perry Y, Courcoulas A, Fernando HC, et al. Laparoscopic Roux-en-Y gastric bypass for recalcitrant gastroesophageal reflux disease in morbidly obese patients. JSLS. 2004;8:19–23.PubMedGoogle Scholar
  52. 52.
    Smith ShC, Edwards Ch, Goodman GN, Symptomatic and clinical improvement in morbidly obese patients with gastroesophageal reflux disease following Roux-en-Y gastric bypass. Obesity Surgery 2007;17:479–84Google Scholar
  53. 53.
    Houghton SG, Nelson LG, Swain JM. Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment. Surg Obes Relat Dis. 2005;1:475–80.PubMedCrossRefGoogle Scholar
  54. 54.
    Kellog TA, Andrade R, Maddaus M, et al. Anatomic findings and outcomes after antireflux procedures in morbidly obese patients undergoing laparoscopic conversion to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;33:52–7.CrossRefGoogle Scholar
  55. 55.
    Houghton SG, Romero Y, Sarr MG. Effect of Roux-en-Y gastric bypass in obese patients with Barrett’s esophagus: attempts to eliminate duodenogastric reflux. Surg Obes Relat Dis. 2008;4:1–4.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2012

Authors and Affiliations

  • Italo Braghetto
    • 1
    Email author
  • Owen Korn
    • 1
  • Attila Csendes
    • 1
  • Luis Gutiérrez
    • 1
  • Héctor Valladares
    • 1
  • Max Chacon
    • 2
  1. 1.Department of SurgeryUniversity of ChileSantiagoChile
  2. 2.Department of Informatics EngineeringUniversity of Santiago de ChileSantiagoChile

Personalised recommendations