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Barrett’s esophagus after Roux-en-Y gastric bypass: does regression occur?

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Abstract

Introduction

Barrett’s esophagus (BE) is recognized as a premalignant lesion for esophageal adenocarcinoma. BE appears as a consequence of gastroesophageal reflux disease (GERD), which is increased among obese population. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the best treatment option for obesity combined with GERD. However, data on evolution of BE after LRYGB are scarce.

Methods and procedures

Patients were studied with esophagogastroduodenoscopy (EGD) and gastric biopsy preoperatively. If BE was suspected, esophageal biopsy was performed. If BE was confirmed, LRYGB was indicated with yearly surveillance EGD with biopsies. LRYGB patients who had BE with at least 1-year follow-up were included.

Results

Between 10/07 and 1/16, 2144 patients underwent laparoscopic bariatric surgery at our institution. There were 1681 (78 %) LRYGB, 399 (19 %) laparoscopic sleeve gastrectomies, and 64 (3 %) revisions. Nineteen patients (0.9 %) had BE preoperatively, and they all underwent LRYGB; 11 of them (58 %) were eligible for this study. There were 6 women and 5 men, mean age 49 ± 11 years, initial BMI 44 ± 6 kg/m2. Mean follow-up was 41 ± 31 months; there were 9 short-segment BE (SSBE) and 2 long-segment BE (LSBE). On pre- and post-op EGD, BE length was 2.1 ± 1.6 and 1.2 ± 1.2 cm, respectively (p = NS). Post-op EGD was compatible with BE in all cases, although esophageal biopsy showed remission in 4 (36 %) cases: three short-segment BE (SSBE) and one long-segment BE (LSBE). One patient was indefinite for dysplasia and remained the same after the operation.

Conclusion

Our preliminary data showed that LRYGB is a suitable treatment option for obese patients with BE, demonstrated by 36 % regression rate of this premalignant disease. Although BE persisted in the remaining patients, no progression to dysplasia was observed. A larger number of patients and longer follow-up are needed for more definitive conclusions.

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Authors and Affiliations

  1. Programa de Unidades Bariátricas, Buenos Aires, Argentina

    Verónica Gorodner, Rudolf Buxhoeveden, Gastón Clemente & Alejandro Grigaites

  2. GEDYT Gastroenterología Diagnóstica y Terapéutica, Buenos Aires, Argentina

    Christian Sánchez & Luis Caro

Authors
  1. Verónica Gorodner
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  2. Rudolf Buxhoeveden
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  3. Gastón Clemente
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  4. Christian Sánchez
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  5. Luis Caro
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  6. Alejandro Grigaites
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Correspondence to Verónica Gorodner.

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Disclosures

Verónica Gorodner, MD, Rudolf Buxhoeveden, MD, Gastón Clemente, MD, Christian Sánchez, MD, Luis Caro, MD, and Alejandro Grigaites, MD have no conflicts of interest or financial ties to disclose.

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Gorodner, V., Buxhoeveden, R., Clemente, G. et al. Barrett’s esophagus after Roux-en-Y gastric bypass: does regression occur?. Surg Endosc 31, 1849–1854 (2017). https://doi.org/10.1007/s00464-016-5184-3

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  • DOI: https://doi.org/10.1007/s00464-016-5184-3

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