Barrett’s Esophagus After Roux-en- Y Gastric Bypass: Does Regression Occur?

Maria Veronica Gorodner, MD, Gaston Clemente, MD, Alejandro Grigaites, MD. Programa Unidades Bariatricas, Argentina

Introduction: Barrett’s esophagus (BE) is recognized as a premalignant lesion for esophageal adenocarcinoma.  BE appears as a consequence of gastroesophageal reflux disease (GERD), which is clearly increased among obese population. There is no question that laparoscopic Roux -en- Y gastric bypass (LRYGB) is the best treatment option for obesity combined with GERD. However, data on evolution of BE after LRYGB are scarce.

Methods and Procedures: Candidates for bariatric surgery were studied with esophagogastroduodenoscopy (EGD) and gastric biopsy preoperatively. If BE was suspected, esophageal biopsy was performed as well. If BE was confirmed, LRYGB was indicated. Patients with BE underwent surveillance EGD with multiple systematic biopsies yearly. Patients undergoing RYGB who had BE with at least 1-year follow up were included in this study. Demographics, pre and postoperative data, and follow up tests were reported.

Results: Between 10/07 and 9/15, 1948 patients underwent laparoscopic bariatric surgery at our institution. There were 1522 (78%) LRYGB, 369 (19%) laparoscopic sleeve gastrectomies (LSG), and 57 (3%) revisions. Sixteen patients had BE preoperatively, and they all underwent RYGB; 9 of them (56%) were eligible for this study. There were 4 women and 5 men, mean age 47±11 years, initial BMI 43±7 kg/m². Mean follow up was 31±35 months; % excess weight loss (EWL) was 56±35. There were 7 short segment BE (SSBE) and 2 long segment (LSBE). On pre and postop EGD, BE length was 2.2±1.9 and 1.9±1.3 cm respectively (p=NS). Postop EGD was compatible con BE in all cases, although esophageal biopsy showed remission in 3 (33%) cases, (2 SSBE and 1 LSBE). One patient was indefinite for dysplasia and remained the same after the operation.

Conclusion: Our preliminary data showed that LRYGB is a suitable treatment option for obese patients with BE, demonstrated by 33% regression rate of this premalignant disease. Although BE persisted in the remaining patients, no progression to dysplasia was observed.

A larger number of patients and longer follow up are needed for more definitive conclusions.