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30.09.2023 | Original Contributions

Barrett`s Esophagus in Bariatric Surgery: Regression or Progression?

verfasst von: Yusef Moulla, Haitham Hamadeh, Lena Seidemann, Matthias Mehdorn, Mathias Blüher, Jürgen Feisthammel, Albrecht Hoffmeister, Ines Gockel, Undine-Gabriele Lange, Arne Dietrich

Erschienen in: Obesity Surgery | Ausgabe 11/2023

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Abstract

Introduction

Morbid obesity is well known as a risk factor for gastroesophageal reflux disease (GERD) and its related disorders such as Barrett’s esophagus (BE). This study aimed to evaluate the development of BE in patients who underwent bariatric surgery.

Materials and Methods

Using a single-center prospectively established database of obese patients who underwent bariatric surgery from 01/2012 to 12/2019, we retrospectively compared the preoperative endoscopic findings of BE to those after 1–2 years and 3–5 years following bariatric surgery. The change of BE was detected endoscopically according to Prague classification and histologically according to the British guidelines of detecting columnar epithelium on the distal esophagus.

Results

Among 914 obese patients who underwent bariatric surgery and received a preoperative esophagogastroduodenoscopy (EGD), we found 119 patients (13%) with BE. A follow-up EGD was performed in 74 of the BE patients (62.2%). A total of 37 (50%) patients underwent a follow-up EGD after 1–2 years and 45 (60.8%) patients underwent it after 3–5 years. Among many clinical parameters, the surgical procedure was the only significant factor for the change of BE after bariatric surgery (p < 0.05). A regression of BE was found in 19 patients (n = 54, 35%) after laparoscopic Roux-en-Y- gastric bypass (LRYGB). Furthermore, a progression of BE was detected in six patients (n = 20, 30%) after laparoscopic sleeve gastrectomy (LSG).

Conclusion

RYGB should be considered in obese patients with BE. Detecting BE prior to bariatric surgery may have an impact on decision-making regarding the suitable surgical bariatric procedure.

Graphical Abstract

Literatur
1.
Zurück zum Zitat El-Serag HB, et al. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol. 2005;100(6):1243–50.CrossRefPubMed El-Serag HB, et al. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol. 2005;100(6):1243–50.CrossRefPubMed
2.
3.
Zurück zum Zitat Herbella FA, et al. Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment. J Gastrointest Surg. 2007;11(3):286–90.CrossRefPubMed Herbella FA, et al. Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment. J Gastrointest Surg. 2007;11(3):286–90.CrossRefPubMed
5.
Zurück zum Zitat Peromaa-Haavisto P, Victorzon M. Is routine preoperative upper GI endoscopy needed prior to gastric bypass? Obes Surg. 2013;23(6):736–9.CrossRefPubMed Peromaa-Haavisto P, Victorzon M. Is routine preoperative upper GI endoscopy needed prior to gastric bypass? Obes Surg. 2013;23(6):736–9.CrossRefPubMed
6.
Zurück zum Zitat Goonawardena J, Ward S. Effect of Roux-en-Y gastric bypass on Barrett’s esophagus: a systematic review. Surg Obes Relat Dis. 2021;17(1):221–30.CrossRefPubMed Goonawardena J, Ward S. Effect of Roux-en-Y gastric bypass on Barrett’s esophagus: a systematic review. Surg Obes Relat Dis. 2021;17(1):221–30.CrossRefPubMed
7.
Zurück zum Zitat Braghetto I, et al. Laparoscopic treatment of obese patients with gastroesophageal reflux disease and Barrett’s esophagus: a prospective study. Obes Surg. 2012;22(5):764–72.CrossRefPubMed Braghetto I, et al. Laparoscopic treatment of obese patients with gastroesophageal reflux disease and Barrett’s esophagus: a prospective study. Obes Surg. 2012;22(5):764–72.CrossRefPubMed
8.
Zurück zum Zitat Madalosso CA, et al. The Impact of Gastric Bypass on Gastroesophageal Reflux Disease in Morbidly Obese Patients. Ann Surg. 2016;263(1):110–6.CrossRefPubMed Madalosso CA, et al. The Impact of Gastric Bypass on Gastroesophageal Reflux Disease in Morbidly Obese Patients. Ann Surg. 2016;263(1):110–6.CrossRefPubMed
9.
Zurück zum Zitat Felsenreich DM, et al. Update: 10 Years of Sleeve Gastrectomy-the First 103 Patients. Obes Surg. 2018;28(11):3586–94.CrossRefPubMed Felsenreich DM, et al. Update: 10 Years of Sleeve Gastrectomy-the First 103 Patients. Obes Surg. 2018;28(11):3586–94.CrossRefPubMed
10.
Zurück zum Zitat Felsenreich DM, et al. Reflux, Sleeve Dilation, and Barrett’s Esophagus after Laparoscopic Sleeve Gastrectomy: Long-Term Follow-Up. Obes Surg. 2017;27(12):3092–101.CrossRefPubMed Felsenreich DM, et al. Reflux, Sleeve Dilation, and Barrett’s Esophagus after Laparoscopic Sleeve Gastrectomy: Long-Term Follow-Up. Obes Surg. 2017;27(12):3092–101.CrossRefPubMed
11.
Zurück zum Zitat Qumseya BJ, et al. Barrett’s esophagus after sleeve gastrectomy: a systematic review and meta-analysis. Gastrointest Endosc. 2021;93(2):343-352 e2.CrossRefPubMed Qumseya BJ, et al. Barrett’s esophagus after sleeve gastrectomy: a systematic review and meta-analysis. Gastrointest Endosc. 2021;93(2):343-352 e2.CrossRefPubMed
12.
Zurück zum Zitat Shaheen NJ, et al. ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus. Am J Gastroenterol. 2016;111(1):30–50 quiz 51.CrossRefPubMed Shaheen NJ, et al. ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus. Am J Gastroenterol. 2016;111(1):30–50 quiz 51.CrossRefPubMed
13.
Zurück zum Zitat Nayar DS, Vaezi MF. Classifications of esophagitis: who needs them? Gastrointest Endosc. 2004;60(2):253–7.CrossRefPubMed Nayar DS, Vaezi MF. Classifications of esophagitis: who needs them? Gastrointest Endosc. 2004;60(2):253–7.CrossRefPubMed
14.
Zurück zum Zitat Sharma P, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology. 2006;131(5):1392–9.CrossRefPubMed Sharma P, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology. 2006;131(5):1392–9.CrossRefPubMed
15.
Zurück zum Zitat Fitzgerald RC, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63(1):7–42.CrossRefPubMed Fitzgerald RC, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63(1):7–42.CrossRefPubMed
16.
Zurück zum Zitat Regan JP, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13(6):861–4.CrossRefPubMed Regan JP, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13(6):861–4.CrossRefPubMed
17.
19.
Zurück zum Zitat Ooi GJ, et al. Perioperative screening, management, and surveillance of Barrett’s esophagus in bariatric surgical patients. Ann N Y Acad Sci. 2020;1481(1):224–35.CrossRefPubMed Ooi GJ, et al. Perioperative screening, management, and surveillance of Barrett’s esophagus in bariatric surgical patients. Ann N Y Acad Sci. 2020;1481(1):224–35.CrossRefPubMed
20.
Zurück zum Zitat El-Serag HB, et al. Abdominal obesity and the risk of Barrett’s esophagus. Am J Gastroenterol. 2005;100(10):2151–6.CrossRefPubMed El-Serag HB, et al. Abdominal obesity and the risk of Barrett’s esophagus. Am J Gastroenterol. 2005;100(10):2151–6.CrossRefPubMed
21.
Zurück zum Zitat Koop H, et al. S2k guideline: gastroesophageal reflux disease guided by the German Society of Gastroenterology: AWMF register no. 021–013. Z Gastroenterol. 2014;52(11):1299–346.PubMed Koop H, et al. S2k guideline: gastroesophageal reflux disease guided by the German Society of Gastroenterology: AWMF register no. 021–013. Z Gastroenterol. 2014;52(11):1299–346.PubMed
22.
Zurück zum Zitat Brown WA, et al. IFSO Position Statement on the Role of Esophago-Gastro-Duodenal Endoscopy Prior to and after Bariatric and Metabolic Surgery Procedures. Obes Surg. 2020;30(8):3135–53.CrossRefPubMed Brown WA, et al. IFSO Position Statement on the Role of Esophago-Gastro-Duodenal Endoscopy Prior to and after Bariatric and Metabolic Surgery Procedures. Obes Surg. 2020;30(8):3135–53.CrossRefPubMed
23.
Zurück zum Zitat Mansour NM, El-Serag HB, Anandasabapathy S. Barrett’s esophagus: best practices for treatment and post-treatment surveillance. Ann Cardiothorac Surg. 2017;6(2):75–87.CrossRefPubMedPubMedCentral Mansour NM, El-Serag HB, Anandasabapathy S. Barrett’s esophagus: best practices for treatment and post-treatment surveillance. Ann Cardiothorac Surg. 2017;6(2):75–87.CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Yanes M, et al. Survival after antireflux surgery versus medication in patients with reflux oesophagitis or Barrett’s oesophagus: multinational cohort study. Br J Surg. 2021;108(7):864–70.CrossRefPubMed Yanes M, et al. Survival after antireflux surgery versus medication in patients with reflux oesophagitis or Barrett’s oesophagus: multinational cohort study. Br J Surg. 2021;108(7):864–70.CrossRefPubMed
25.
Zurück zum Zitat Abdelrahman T, et al. Outcomes after laparoscopic anti-reflux surgery related to obesity: A systematic review and meta-analysis. Int J Surg. 2018;51:76–82.CrossRefPubMed Abdelrahman T, et al. Outcomes after laparoscopic anti-reflux surgery related to obesity: A systematic review and meta-analysis. Int J Surg. 2018;51:76–82.CrossRefPubMed
26.
Zurück zum Zitat Bashir Y, et al. Systematic review and meta-analysis on the effect of obesity on recurrence after laparoscopic anti-reflux surgery. Surgeon. 2019;17(2):107–18.CrossRefPubMed Bashir Y, et al. Systematic review and meta-analysis on the effect of obesity on recurrence after laparoscopic anti-reflux surgery. Surgeon. 2019;17(2):107–18.CrossRefPubMed
27.
Zurück zum Zitat Csendes A, et al. Effect of gastric bypass on Barrett’s esophagus and intestinal metaplasia of the cardia in patients with morbid obesity. J Gastrointest Surg. 2006;10(2):259–64.CrossRefPubMed Csendes A, et al. Effect of gastric bypass on Barrett’s esophagus and intestinal metaplasia of the cardia in patients with morbid obesity. J Gastrointest Surg. 2006;10(2):259–64.CrossRefPubMed
28.
Zurück zum Zitat Cobey F, Oelschlager B. Complete regression of Barrett’s esophagus after Roux-en-Y gastric bypass. Obes Surg. 2005;15(5):710–2.CrossRefPubMed Cobey F, Oelschlager B. Complete regression of Barrett’s esophagus after Roux-en-Y gastric bypass. Obes Surg. 2005;15(5):710–2.CrossRefPubMed
29.
Zurück zum Zitat Gorodner V, et al. Barrett’s esophagus after Roux-en-Y gastric bypass: does regression occur? Surg Endosc. 2017;31(4):1849–54.CrossRefPubMed Gorodner V, et al. Barrett’s esophagus after Roux-en-Y gastric bypass: does regression occur? Surg Endosc. 2017;31(4):1849–54.CrossRefPubMed
30.
Zurück zum Zitat Andrew B, et al. Barrett’s esophagus before and after Roux-en-Y gastric bypass for severe obesity. Surg Endosc. 2018;32(2):930–6.CrossRefPubMed Andrew B, et al. Barrett’s esophagus before and after Roux-en-Y gastric bypass for severe obesity. Surg Endosc. 2018;32(2):930–6.CrossRefPubMed
31.
Zurück zum Zitat Signorini F, et al. Impact of Gastric Bypass on Erosive Esophagitis and Barret’s Esophagus. Obes Surg. 2020;30(4):1194–9.CrossRefPubMed Signorini F, et al. Impact of Gastric Bypass on Erosive Esophagitis and Barret’s Esophagus. Obes Surg. 2020;30(4):1194–9.CrossRefPubMed
32.
33.
Zurück zum Zitat Angrisani L, et al. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg. 2018;28(12):3783–94.CrossRefPubMed Angrisani L, et al. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg. 2018;28(12):3783–94.CrossRefPubMed
34.
Zurück zum Zitat Melissas J, et al. Gastroesophageal Reflux Disease and Sleeve Gastrectomy. Obes Surg. 2015;25(12):2430–5.CrossRefPubMed Melissas J, et al. Gastroesophageal Reflux Disease and Sleeve Gastrectomy. Obes Surg. 2015;25(12):2430–5.CrossRefPubMed
35.
Zurück zum Zitat Yeung KTD, et al. Does Sleeve Gastrectomy Expose the Distal Esophagus to Severe Reflux?: A Systematic Review and Meta-analysis. Ann Surg. 2020;271(2):257–65.CrossRefPubMed Yeung KTD, et al. Does Sleeve Gastrectomy Expose the Distal Esophagus to Severe Reflux?: A Systematic Review and Meta-analysis. Ann Surg. 2020;271(2):257–65.CrossRefPubMed
36.
Zurück zum Zitat Elkassem S. Gastroesophageal Reflux Disease, Esophagitis, and Barrett’s Esophagus 3 to 4 Years Post Sleeve Gastrectomy. Obes Surg. 2021;31(12):5148–55.CrossRefPubMed Elkassem S. Gastroesophageal Reflux Disease, Esophagitis, and Barrett’s Esophagus 3 to 4 Years Post Sleeve Gastrectomy. Obes Surg. 2021;31(12):5148–55.CrossRefPubMed
Metadaten
Titel
Barrett`s Esophagus in Bariatric Surgery: Regression or Progression?
verfasst von
Yusef Moulla
Haitham Hamadeh
Lena Seidemann
Matthias Mehdorn
Mathias Blüher
Jürgen Feisthammel
Albrecht Hoffmeister
Ines Gockel
Undine-Gabriele Lange
Arne Dietrich
Publikationsdatum
30.09.2023
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 11/2023
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-023-06829-3

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