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Endoscopic Follow-Up Between 3 and 7 Years After Sleeve Gastrectomy Reveals Antral Reactive Gastropathy but no Barrett’s Esophagus

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Abstract

Background

The main concerns following sleeve gastrectomy (SG) include the risk of gastroesophageal reflux disease (GERD) and its complications, such as Barrett’s esophagus (BE). However, there is conflicting data on esophageal conditions, and studies on alterations of gastric mucosa after SG are lacking, despite reported cases of gastric cancer. Our aim was to assess esophageal and gastric lesions after SG.

Methods

From November 2017, an upper gastrointestinal endoscopy (UGE) was proposed at least 3 years after SG to all patients operated on in our institution. Endoscopic results and gastric histological findings were analyzed. BE was defined as endoscopically suspected esophageal metaplasia with histological intestinal metaplasia.

Results

Between September 2008 and August 2018, 375 patients underwent SG at our institution, of which 162 (43%) underwent at least one UGE 3 years or more after SG (91% women, mean preoperative age: 43.3±10.3 years). Despite a significant increase in the prevalence of symptomatic GERD, hiatal hernia, and esophagitis after SG (p<0.001 vs. preoperatively), no cases of BE were detected. Gastric dysplasia was not found and the prevalence of gastric atrophy tended to decrease after SG. However, 27% of patients with gastric biopsies developed antral reactive gastropathy.

Conclusions

At a mean follow-up of 54 months after SG, no BE or gastric dysplasia was identified. However, reactive gastric lesions appeared, and their long-term consequences need to be further clarified. Thus, the timing of endoscopic follow-up, starting as early as 3 years after SG should be reevaluated to improve patient adherence with long-term endoscopies.

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Data Availability

The data that support the findings of this study are available on request from the corresponding author.

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Author information

Authors and Affiliations

  1. Université Paris Cité, Centre de Recherche sur l’Inflammation, Inserm UMRS 1149, 75018, Paris, France

    Muriel Coupaye, Henri Duboc, Daniela Calabrese, David Moszkowicz, Maude Le Gall, Heithem Soliman & Séverine Ledoux

  2. Assistance Publique-Hôpitaux de Paris, Service des Explorations Fonctionnelles, Centre Intégré Nord Francilien de prise en charge de l’Obésité (CINFO), Hôpital Louis-Mourier, 92700, Colombes, France

    Muriel Coupaye, Aude Pacheco & Séverine Ledoux

  3. Assistance Publique-Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Louis-Mourier, 92700, Colombes, France

    Caroline Gorbatchef, Marie Dior, Henri Duboc & Heithem Soliman

  4. Assistance Publique-Hôpitaux de Paris, Service de Chirurgie Digestive, Centre Intégré Nord Francilien de prise en charge de l’Obésité (CINFO), Hôpital Bichat-Claude-Bernard, 75018, Paris, France

    Daniela Calabrese

  5. Assistance Publique-Hôpitaux de Paris, Service de Chirurgie Digestive, Centre Intégré Nord Francilien de prise en charge de l’Obésité (CINFO), Hôpital Louis-Mourier, 92700, Colombes, France

    David Moszkowicz

  6. Assistance Publique-Hôpitaux de Paris, Service d’Anatomo-Pathologie, Hôpital Bichat-Claude-Bernard, 75018, Paris, France

    Ruiqian Chen

Authors
  1. Muriel Coupaye
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  2. Caroline Gorbatchef
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  8. Maude Le Gall
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  10. Heithem Soliman
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  11. Séverine Ledoux
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Corresponding author

Correspondence to Muriel Coupaye.

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The authors declare no competing interests.

Ethics Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Key points

• No Barrett’s esophagus was found in patients at a mean follow-up of 54 months after SG

• The prevalence of histological gastric atrophy tended to decrease 54 months after SG

• An antral reactive gastropathy appeared in 27% of patients 54 months after SG

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Coupaye, M., Gorbatchef, C., Dior, M. et al. Endoscopic Follow-Up Between 3 and 7 Years After Sleeve Gastrectomy Reveals Antral Reactive Gastropathy but no Barrett’s Esophagus. OBES SURG 33, 3112–3119 (2023). https://doi.org/10.1007/s11695-023-06785-y

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