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13.07.2019 | Review | Ausgabe 11/2019

Obesity Surgery 11/2019

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

Zeitschrift:
Obesity Surgery > Ausgabe 11/2019
Autoren:
Md Tanveer Adil, Omer Al-taan, Farhan Rashid, Aruna Munasinghe, Vigyan Jain, Douglas Whitelaw, Periyathambi Jambulingam, Kamal Mahawar
Wichtige Hinweise
Suggested text for special media/twitter: Roux-en-Y Gastric Bypass leads to regression of Barrett’s Esophagus in more than 50% patients.

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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