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Surgical Endoscopy

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01-04-2017

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

Authors: Verónica Gorodner, Rudolf Buxhoeveden, Gastón Clemente, Christian Sánchez, Luis Caro, Alejandro Grigaites

Published in: Surgical Endoscopy | Issue 4/2017

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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Title: Barrett’s esophagus after Roux-en-Y gastric bypass: does regression occur?
Authors: Verónica Gorodner
Rudolf Buxhoeveden
Gastón Clemente
Christian Sánchez
Luis Caro
Alejandro Grigaites
Publication date: 01-04-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5184-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Introduction

Methods and procedures

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods and procedures

Results

Conclusion

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