Obesity Surgery

, Volume 29, Issue 11, pp 3712–3721 | Cite as

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

  • Md Tanveer AdilEmail author
  • Omer Al-taan
  • Farhan Rashid
  • Aruna Munasinghe
  • Vigyan Jain
  • Douglas Whitelaw
  • Periyathambi Jambulingam
  • Kamal Mahawar



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.


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.


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).


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.


Gastric bypass Roux-en-Y gastric bypass Barrett’s esophagus Gastroesophageal reflux Meta-analysis 



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.

Authors’ 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.

Compliance with Ethical Standards

Ethics Approval

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.

Competing Interests

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

Consent to Participate

We declare that consent to participate is not applicable to this study.

Consent to Publish

We declare that consent to publish is not applicable to this study.


  1. 1.
    Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.Google Scholar
  2. 2.
    Moersch RN, Ellis Jr FH, Mc DJ. Pathologic changes occurring in severe reflux esophagitis. Surg Gynecol Obstet. 1959;108:476–84.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Stein HJ, Siewart JR. Barrett's esophagus: pathogenesis, epidemiology, functional abnormalities, malignant degeneration, and surgical management. Dysphagia. 1993;8(3):276–88.Google Scholar
  4. 4.
    Hamade N, Vennelaganti S, Parasa S, et al. Lower annual rate of progression of short-segment vs long-segment Barrett’s esophagus to esophageal adenocarcinoma. Clin Gastroenterol Hepatol. 2019;17(5):864-868.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Runge TM, Abrams JA, Shaheen NJ. Epidemiology of Barrett’s esophagus and esophageal adenocarcinoma. Gastroenterol Clin N Am. 2015;44(2):203–31.Google Scholar
  6. 6.
    Westhoff B, Brotze S, Weston A, et al. The frequency of Barrett’s esophagus in high-risk patients with chronic GERD. Gastrointest Endosc. 2005;61(2):226–31.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Braghetto I, Csendes A. Patients having bariatric surgery: surgical options in morbidly obese patients with Barrett’s esophagus. Obes Surg. 2016;26:1622–6.Google Scholar
  8. 8.
    Nandurkar S, Locke 3rd GR, Fett S, et al. Relationship between body mass index, diet, exercise and gastro-oesophageal reflux symptoms in a community. Aliment Pharmacol Ther. 2004;20(5):497–505.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Kubo A, Corley DA. Body mass index and adenocarcinomas of the esophagus or gastric cardia: a systematic review and meta-analysis. Cancer Epidemiol Biomark Prev. 2006;15:872–8.Google Scholar
  10. 10.
    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.Google Scholar
  11. 11.
    Sampliner RE. Practice guidelines on the diagnosis, surveillance, and therapy of Barrett’s esophagus. Am J Gastroenterol. 1998;93:1028–32.Google Scholar
  12. 12.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017;27(9):2279–89.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Zhang N, Maffei A, Cerabona T, et al. Reduction in obesity-related comorbidities: is gastric bypass better than sleeve gastrectomy? Surg Endosc. 2013;27(4):1273–80.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Park C, Portenier D. Reflux, Barrett’s esophagus & bariatric surgery: working towards a clinical pathway for the management of a pre-cancerous condition in bariatric surgery patients. Surg Obes Relat Dis. 2015;11(6):S118.Google Scholar
  15. 15.
    Cobey F, Oelschlager B. Complete regression of Barrett’s esophagus after Roux-en-Y gastric bypass. Obes Surg. 2005;15:710–2.PubMedPubMedCentralGoogle Scholar
  16. 16.
    O'Connor D, Green S, Higgins JPT. Defining the review question and developing criteria for including studies. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0: The Cochrane Collaboration; 2013. Available at - Accessed 27 Feb 2019.
  17. 17.
    Centre for reviews and dissemination. Systematic reviews: CRD's guidance for undertaking reviews in healthcare. York: University of York; 2009. Available at - Accessed 27 Feb 2019.
  18. 18.
    Moher D, Liberali A, Telzlaff J, et al. Preferred reporting items for systematic reviews and meta-analysis: the PRISMA statement. BMJ. 2009;339:b2535.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20(1):37–46.Google Scholar
  20. 20.
    Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712–6.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Lewis S, Clarke M. Forest plots: trying to see the wood and the trees. BMJ. 2001;322(7300):1479–80.Google Scholar
  22. 22.
    Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Higgins JPT, Thompson SG, Deeks JJ. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.PubMedPubMedCentralGoogle Scholar
  24. 24.
    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 Gastrointest Surg. 2006;10(2):259–64.Google Scholar
  25. 25.
    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):1–4.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Ben-Meir A, Sonpal I, Salomone MG. Roux-en-Y gastric bypass (RYGB) improves Barrett’s esophagus. Surg Obes Relat Dis. 2010;6(3):S48–9.Google Scholar
  27. 27.
    Braghetto I, Korn O, Csendes A, et al. Laparoscopic treatment of obese patients with gastroesophageal reflux disease and Barrett’s esophagus: a prospective study. Obes Surg. 2012;22(5):764–72.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Pereira N, Csendes A, Smok G, et al. Effects of gastric bypass for morbid obesity on Barrett esophagus. Rev Chilena Cirugía. 2012;64(2):155–60.Google Scholar
  29. 29.
    Dova G, Caro LE, Brasesco O, et al. Effects of gastric bypass in obese patients with Barrett’s esophagus. Gastrointest Endosc. 2016;83(5):AB551.Google Scholar
  30. 30.
    Gorodner V, Buxhoeveden R, Clemente G, et al. Barrett’s esophagus after roux-en-Y gastric bypass: does regression occur? Surg Endosc. 2017;31(4):1849–54.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Andrew B, Alley JB, Aquiar CE, et al. Barrett’s esophagus before and after Roux-en-Y gastric bypass for severe obesity. Surg Endosc. 2018;32(2):930–6.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Nguyen DM, El-Serag HB, Henderson L, et al. Medication usage and the risk of neoplasia in patients with Barrett’s esophagus. Clin Gastroenterol Hepatol. 2009;7:1299–304.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360:2277–88.Google Scholar
  34. 34.
    Gray NA, Odze RD, Spechler SJ. Buried metaplasia after endoscopic ablation of Barrett’s esophagus: a systematic review. Am J Gastroenterol. 2011;106:1899–908.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Mino-Kenudson M, Brugge WR, Puricelli WP, et al. Management of superficial Barrett’s epithelium-related neoplasms by endoscopic mucosal resection: clinicopathologic analysis of 27 cases. Am J Surg Pathol. 2005;29:680–6.Google Scholar
  36. 36.
    Pouw RE, Seewald S, Gondrie JJ, et al. Stepwise radical endoscopic resection for eradication of Barrett’s oesophagus with early neoplasia in a cohort of 169 patients. Gut. 2010;59:1169–77.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Simonka Z, Paszt A, Abraham S, et al. The effects of laparoscopic Nissen fundoplication on Barrett’s esophagus: long-term results. Scand J Gastroenterol. 2012;47:13–21.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Hofstetter WL, Peters JH, DeMeester TR, et al. Long-term outcome of antireflux surgery in patients with Barrett’s esophagus. Ann Surg. 2001;234:532–8.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Guruski RR, Peters JH, Hagen JA, et al. Barrett’s esophagus can and does regress after antireflux surgery: a study of prevalence and predictive features. J Am Coll Surg. 2003;196(5):706–12.Google Scholar
  40. 40.
    Parrilla P, Martinez de Haro LF, Ortiz A, et al. Long-term results of a randomized prospective study comparing medical and surgical treatment of Barrett’s esophagus. Ann Surg. 2003;237:291–8.Google Scholar
  41. 41.
    Zehetner J, DeMeester SR, Ayazi S, et al. Long-term follow-up after anti-reflux surgery in patients with Barrett’s esophagus. J Gastrointest Surg. 2010;14:1483–91.Google Scholar
  42. 42.
    Kellogg 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;3(1):52–7.Google Scholar
  43. 43.
    Morgenthal CB, Lin E, Shane MD, et al. Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc. 2007;21(11):1978–84.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001;15:986–9.Google Scholar
  45. 45.
    Sauerland S, Angrisani L, Belachew M, et al. Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2005;19:200–21.Google Scholar
  46. 46.
    Anderson MA, Gan SI, Fanelli RD, et al. Role of endoscopy in the bariatric surgery patient. Gastrointest Endosc. 2008;68:1–10.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Abd EME, Alfalah H, Asker WA, et al. Place of upper endoscopy before and after bariatric surgery: a multicenter experience with 3219 patients. World J Gastrointest Endosc. 2016;8(10):409–17.Google Scholar
  48. 48.
    Gomez V, Bhalla R, Heckman MG, et al. Routine screening endoscopy before bariatric surgery: is it necessary? Bariatr Surg Pract Patient Care. 2014;9(4):143–9.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Upper GI and Bariatric SurgeryLuton and Dunstable University HospitalLutonUnited Kingdom
  2. 2.Department of General SurgerySunderland Royal HospitalSunderlandUnited Kingdom

Personalised recommendations