SLEEVE gastrectomy (SG), one of the most widely performed bariatric procedures worldwide, is associated with an increased risk of developing Barrett’s oesophagus (BE), according to a recent systematic review and meta-analysis.
The team conducted a literature search of studies reporting on the incidence of BE, erosive esophagitis (EE), and hiatal hernia (HH) following SG. Primary outcomes included post-SG pooled rates of de novo BE, EE, gastroesophageal reflux disease (GERD) symptoms, proton pump inhibitor use, and HH. Researchers analysed data from a total of 19 studies involving 2,046 patients (79% female; mean age: 42.2 years; follow-up period: 2–11.4 years) and performed a meta-regression analysis to assess if patient and post-SG factors influenced the rates of post-SG BE.
The study found that 5.6% of patients developed de novo BE following SG, a significant concern given the potential progression of BE to more serious conditions like oesophageal cancer. The analysis also revealed that patients who underwent SG were at a significantly higher risk of developing other gastrointestinal issues. Specifically, the pooled rates for EE and HH were markedly increased, with risk ratios of 3.37 and 2.09, respectively. Additionally, the risk of experiencing GERD symptoms, and the subsequent need for proton pump inhibitor therapy, also increased substantially, with risk ratios of 3.32 and 3.65, respectively.
Interestingly, while GERD symptoms post-SG were found to significantly influence the incidence of BE, factors such as age, sex, BMI, and the presence of EE or HH after SG did not positively influence BE rates.
Based on this evidence for increased risk for BE after SG, the authors advised that clinicians should routinely screen patients with SG for BE, and follow societal guidelines for surveillance. Gastroenterologists “need to be aware of the heightened risk for BE in these patients and, regardless of symptomology, should consider doing a screening endoscopy to detect BE early,” said lead author Saurabh Chandan, Center for Interventional Endoscopy, Advent Health, Orlando, Florida, USA.
Ada Enesco, EMJ
Reference
Chandan S et al. Risk of de novo Barrett’s esophagus post sleeve gastrectomy: a systematic review and meta-analysis of studies with long term follow up. Clin Gastroenterol Hepatol. 2024; DOI:10.1016/j.cgh.2024.06.041
