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. 2023 Jul;19(7):707-715.
doi: 10.1016/j.soard.2023.02.012. Epub 2023 Feb 27.

Prospective clinical cohort study: low incidence of Barrett esophagus but high rate of reflux disease at 5-year follow-up after sleeve gastrectomy versus Roux-en-Y gastric bypass

Bettina K Wölnerhanssen  1 , Anne C Meyer-Gerspach  2 , Rahel Nussbaumer  3 , Matthias Sauter  4 , Miriam Thumshirn  5 , Marco Bueter  6 , Diana Vetter  7 , Christoph Gubler  8 , Bernhard Morell  8 , Alissa Jell  9 , Michael Vieth  10 , Christoph Beglinger  2 , Ralph Peterli  11 , Mark Fox  12
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Free article

Prospective clinical cohort study: low incidence of Barrett esophagus but high rate of reflux disease at 5-year follow-up after sleeve gastrectomy versus Roux-en-Y gastric bypass

Bettina K Wölnerhanssen et al. Surg Obes Relat Dis. 2023 Jul.
Free article

Abstract

Background: Gastroesophageal reflux disease seems more frequent after laparoscopic sleeve gastrectomy (LSG) than Roux-en-Y gastric bypass (LRYGB). Retrospective case series have raised concerns about a high incidence of Barrett esophagus (BE) after LSG.

Objective: This prospective clinical cohort study compared the incidence of BE ≥5 years after LSG and LRYGB.

Setting: St. Clara Hospital, Basel, and University Hospital, Zürich, Switzerland.

Methods: Patients were recruited from 2 bariatric centers where preoperative gastroscopy is standard practice and LRYGB is preferred for patients with preexisting gastroesophageal reflux disease. At follow-up ≥5 years after surgery, patients underwent gastroscopy with quadrantic biopsies from the squamocolumnar junction and metaplastic segment. Symptoms were assessed using validated questionnaires. Wireless pH measurement assessed esophageal acid exposure.

Results: A total of 169 patients were included, with a median 7.0 ± 1.5 years after surgery. In the LSG group (n = 83), 3 patients had endoscopically and histologically confirmed de novo BE; in the LRYGB group (n = 86), there were 2 patients with BE, 1 de novo and 1 preexisting (de novo BE, 3.6% versus 1.2%; P = .362). At follow-up, reflux symptoms were reported more frequently by the LSG group than by the LRYGB group (51.9% versus 10.5%). Similarly, moderate-to-severe reflux esophagitis (Los Angeles grade B-D) was more common (27.7% versus 5.8%) despite greater use of proton pump inhibitors (49.4% versus 19.7%), and pathologic acid exposure was more frequent in patients who underwent LSG than in patients who underwent LRYGB.

Conclusions: After at least 5 years of follow-up, a higher incidence of reflux symptoms, reflux esophagitis, and pathologic esophageal acid exposure was found in patients who underwent LSG compared with patients who underwent LRYGB. However, the incidence of BE after LSG was low and not significantly different between the 2 groups.

Keywords: Bariatric surgery; Barrett; Gastroesophageal reflux disease; Obesity; Roux-en-Y gastric bypass; Sleeve gastrectomy; esophagus.

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Comment in

  • Response to "Letter to the Editor".
    Peterli R, Fox M. Peterli R, et al. Surg Obes Relat Dis. 2023 Sep;19(9):1078-1079. doi: 10.1016/j.soard.2023.06.001. Epub 2023 Jun 7. Surg Obes Relat Dis. 2023. PMID: 37453838 No abstract available.

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