Barrett's Esophagus and Histologic Esophagitis After Laparoscopic Sleeve Gastrectomy: A Long-term Prospective...

Laparoscopic sleeve gastrectomy (LSG) is associated with gastroesophageal reflux disease (GERD), but long-term esophageal mucosal changes, including Barrett's esophagus (BE), remain incompletely characterized. Symptom-based surveillance may underestimate histologic abnormalities.

Prospective evaluation of a historical cohort of 50 adults who underwent primary LSG more than 8 years earlier and accepted to undergo systematic endoscopy. All included patients underwent standardized high-definition upper endoscopy with Seattle protocol biopsies regardless of symptoms. BE was defined as columnar epithelium with specialized intestinal metaplasia. GERD was assessed by symptoms and Los Angeles classification. Baseline characteristics were compared between included and non-included patients to assess selection bias.

Compared to non-included patients (n = 266), included patients were older (43.2 vs. 38.5 years, p = 0.001) and had lower preoperative hiatal hernia prevalence (14% vs. 36%, p = 0.004). Sixty-six per cent were female. Weight decreased from 112.7 ± 15.3 kg to 85.2 ± 17.9 kg (p < 0.001), with mean %TWL of 24.2 ± 12.7%. GERD symptoms increased from 26% preoperatively to 50% at follow-up (p = 0.023); 82% were taking PPIs. Histology revealed esophagitis in 46% and BE in 4% (2/50). Significant endoscopic-histologic discordance was observed (p = 0.002): 40% had biopsy-proven esophagitis despite normal endoscopic appearance.

LSG achieved durable weight loss but was associated with increased GERD symptoms and high prevalence of histologic esophagitis at more than 8 years. Marked discordance between symptoms, endoscopic appearance, and histopathology supports systematic biopsy-based surveillance after LSG, independent of symptoms or macroscopic findings.