T.J. Alexander1, A. Soetikno1, D.J. Vitello3, C.S. Valukas3, J.E. Sanchez3, M.R. Liggett3, M. Gutierrez4, E.N. Teitelbaum3, E.S. Hungness3, D.J. Bentrem2 1Feinberg School Of Medicine – Northwestern University, Chicago, IL, USA 2Feinberg School Of Medicine – Northwestern University, Northwestern Quality Improvement, Research, & Education In Surgery (NQUIRES), Department Of Surgery, Chicago, IL, USA 3Feinberg School Of Medicine – Northwestern University, Department Of Surgery, Chicago, IL, USA 4University Of Illinois At Chicago, Chicago, IL, USA
Introduction: Sleeve gastrectomy (SG) for weight loss has been associated with higher incidences of gastroesophageal reflux disease (GERD) symptoms and esophagitis postoperatively compared to Roux-en-Y gastric bypass (RNYGB). However, it is unclear whether these associations result in an increased incidence of Barrett’s esophagus (BE), a precancerous complication of GERD. This study aimed to characterize the rate of BE, GERD, and GERD-related sequelae after SG and RNYGB.
Methods: Patients undergoing RNYGB and SG between January 2003 and July 2023 were identified within the enterprise data warehouse of Northwestern Medicine, a large, regional healthcare system. Patients undergoing SG and RNYGB were the main comparison groups. Patients, outcomes, and procedures were identified by validated CPT and ICD-9/-10 codes. The primary outcome of interest was the post-bariatric surgery diagnosis of BE. The secondary outcome of interest was development of other GERD sequelae after bariatric surgery. Medical records of patients who underwent esophagogastroduodenoscopy (EGD) before bariatric surgery and greater than 1 year after surgery were manually reviewed to identify outcomes of interest. Only postoperative EGD reports >1 year after surgery were reviewed to capture postsurgical development of GERD and BE. Sequelae of GERD were defined as: erosive esophagitis, esophageal stricture, and BE. Fisher exact test was used to compare rates of outcomes of interest.
Results: Of 4430 patients undergoing bariatric surgery, 1469 (33.2%) RNYGB and 3027 (68.3%) SG patients were identified. The median (IQR) age was 44 (36-52) years. 3535 (79.8%) were female and 2678 (60.4%) were white. Among patients who underwent RNYGB, 739 (50.3%) were prescribed a proton pump inhibitor (PPI), 763 (51.9%) had a diagnosis of GERD, and 95 (6.5%) had a diagnosis of BE preoperatively. Among patients who underwent SG, 935 (30.9%) were prescribed a PPI, 858 (28.3%) had a diagnosis of GERD, and 46 (1.5%) had a diagnosis of BE preoperatively. Significantly more patients were diagnosed with GERD after SG compared to RNYGB (25.4% vs. 16.5%; p<0.001). Eighty (2.6%) patients who underwent SG had pre- and postoperative EGD, and 57 (3.9%) patients who underwent RNYGB had pre- and postoperative EGD (P=0.023). Of these patients, only 12 RNYGB and 22 SG patients had their postoperative EGD done >1 year after surgery. Among these patients, 2 (9.1%) SG patients developed BE compared to zero in the RNYGB group (P=0.036). Additionally, 2 (9.1%) SG patients developed erosive esophagitis compared to zero patients in the RNYGB group (P=0.036). In total, 19 new cases of BE were identified after SG by ICD code and manual review.
Conclusion: The development of BE and erosive esophagitis was greater after SG compared to RNYGB. Results of this study support the 2021 American Society for Metabolic and Bariatric Surgery position statement to perform surveillance endoscopy on patients who have undergone SG.