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Obesity Surgery
Published in: Obesity Surgery 2/2020

01-02-2020 | Bariatric Surgery | Original Contributions

The Long-term Impact of Roux-en-Y Gastric Bypass on Colorectal Polyp Formation and Relation to Weight Loss Outcomes

Authors: Hisham Hussan, Alyssa Drosdak, Melissa Le Roux, Kishan Patel, Kyle Porter, Steven K. Clinton, Brian Focht, Sabrena Noria

Published in: Obesity Surgery | Issue 2/2020

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Abstract

Background

Evolving epidemiological data, backed by mechanistic evidence, supports a paradoxical increase in the risk of colorectal cancer after Roux-en-Y gastric bypass surgery (RYGB). We examined the risk of colonic polyps after RYGB.

Methods

A single-center retrospective study included colonoscopies performed between the years 1994 and 2018. To focus on the long-term impact of RYGB on precancerous colonic polyps, we compared patients at average risk for CRC who underwent colonoscopy ≥ 5 years after RYGB (n = 86) versus pre-RYGB (n = 106). We analyzed our data using inverse probability of treatment weighting (IPTW) using propensity scores in order to account for multiple potential confounders.

Results

After IPTW, we found no statistical differences between pre- and post-RYGB patients for risk of any polyp (33.2% pre- vs. 32.7% post-RYGB). However, the percentage of serrated polyps was higher ≥ 5 years post-RYGB compared with pre-RYGB (8.7% vs. 2.1%, p = 0.04, relative risk = 4.22; 95% CI 0.97, 18.4). Body mass index ≥ 30 kg/m2 at time of colonoscopy was associated with a greater risk for any polyp after RYGB (OR 6.23; 95% CI 1.16, 33.41). There was also a trend towards increased risk of polyps in post-RYGB patients who were current smokers (OR = 4.97; 95% CI 0.82, 30) or with age > 55 years (OR = 2.49; 95% CI 0.88, 7.00).

Conclusion

Our data suggest that RYGB is associated with an increased risk of serrated polyps after 5 years from surgery. Prospective studies defining this risk and examining mechanisms will be instrumental for application of CRC preventative strategies in this population.
Appendix
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Metadata
Title
The Long-term Impact of Roux-en-Y Gastric Bypass on Colorectal Polyp Formation and Relation to Weight Loss Outcomes
Authors
Hisham Hussan
Alyssa Drosdak
Melissa Le Roux
Kishan Patel
Kyle Porter
Steven K. Clinton
Brian Focht
Sabrena Noria
Publication date
01-02-2020
Publisher
Springer US
Published in
Obesity Surgery / Issue 2/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-019-04176-w

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