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

Area of Science:

• Gastroenterology
• Bariatric Surgery
• Oncology

Background:

• Morbid obesity is a significant risk factor for gastroesophageal reflux disease (GERD) and its sequelae, including Barrett's esophagus (BE).
• Bariatric surgery is increasingly performed in obese individuals, necessitating an understanding of its impact on GERD-related conditions like BE.

Purpose of the Study:

• To evaluate the development and progression of Barrett's esophagus (BE) in patients following bariatric surgery.
• To compare the effects of different bariatric surgical procedures on BE.

Main Methods:

• Retrospective analysis of a prospectively established database of obese patients who underwent bariatric surgery between 2012 and 2019.
• Comparison of preoperative endoscopic findings of BE with those at 1-2 and 3-5 years post-surgery, utilizing Prague classification and British guidelines for histological assessment.

Main Results:

• Out of 914 patients, 119 (13%) had preoperative BE. Follow-up endoscopy was performed on 74 patients.
• Barrett's esophagus regression occurred in 35% of patients (19/54) after laparoscopic Roux-en-Y- gastric bypass (LRYGB).
• Barrett's esophagus progression was observed in 30% of patients (6/20) after laparoscopic sleeve gastrectomy (LSG).

Conclusions:

• The type of bariatric surgical procedure significantly influences the change in Barrett's esophagus.
• Laparoscopic Roux-en-Y- gastric bypass (LRYGB) appears more effective in achieving BE regression compared to laparoscopic sleeve gastrectomy (LSG).
• Preoperative detection of BE is crucial for guiding the choice of bariatric surgery to optimize patient outcomes.