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 |
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| Institution: | 1. St. Clara Research Ltd., Basel, Switzerland;2. Department of Clinical Research, University of Basel, Basel, Switzerland;3. Department of Visceral Surgery, Clarunis University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland;4. Department of Gastroenterology, Clarunis University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital, Basel, Switzerland;5. Department of Gastroenterology, University Hospital, Zürich, Switzerland;6. Department of Visceral and Transplantation Surgery, University Hospital, Zürich, Switzerland;7. Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany;8. Institute for Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Bayreuth, Germany;9. Laboratory and Clinic for Motility Disorders and Functional Digestive Diseases, Klinik Arlesheim, Arlesheim, Switzerland |
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| Abstract: | BackgroundGastroesophageal 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.ObjectiveThis prospective clinical cohort study compared the incidence of BE ≥5 years after LSG and LRYGB.SettingSt. Clara Hospital, Basel, and University Hospital, Zürich, Switzerland.MethodsPatients 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.ResultsA 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.ConclusionsAfter 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. |
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| Keywords: | Obesity Bariatric surgery Sleeve gastrectomy Roux-en-Y gastric bypass Barrett esophagus Gastroesophageal reflux disease |
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