Robert Fanelli, MD, FACS, Joshua Alley, MD, FACS, Brandon Andrew, MD. Robert Packer Hospital
INTRODUCTION: Barrett’s esophagus (BE) has been associated with obesity and metabolic syndrome. Laparoscopic Roux-En-Y gastric bypass (LRYGB) may represent a surgical approach which addresses both severe obesity and BE. LRYGB diverts bile away from the gastric pouch and esophagus due to the long Roux limb, and virtually no acid is produced in the cardia-based gastric pouch. Furthermore, surgically induced weight loss may diminish systemic inflammation, which may contribute to metaplastic changes in the esophagus. Moreover, improved compliance with proton pump inhibitor therapy, as a consequence of enrolling in a bariatric program will decrease acid production further. Decreased doudeno-gastro-esophageal reflux should lead to decreased BE. In this study we examine the effect of LRYGB on regression of BE.
METHODS AND PROCEDURES: We performed a review of all patients with biopsy proven BE, who underwent LRYGB at our institution. A total of 19 patients were identified. A subset of those patients were identified who had at least 1 year of clinical, endoscopic or histological data, a total of 14 patients. Seven of these patients had symptoms of gastroesophageal reflux. All nineteen patients had short segment BE. One patient had low-grade dysplasia.
RESULTS: Post-LRYGB, 6 of 14 (42.9%) patients had histologic regression of BE to normal esophageal mucosa, with no evidence of ongoing BE. 13 of 14 patients (92.8%) reported compliance with continuing PPI therapy for at least the first year after surgery. Body mass index for the group of 14 patients improved from 46.6 kg/m2 to 30.3 kg/m2.
CONCLUSIONS: We recommend LRYGB as an effective combined bariatric and anti-reflux surgical procedure for patients with severe obesity and BE. In short-term follow-up, LRYGB achieved endoscopic and histologic regression to normal mucosa in a substantial number of the patients in our series. Long-term follow-up for patients with BE according to standard surveillance protocols is still recommended until longer-term studies of the impact of LRYGB on BE have been concluded.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77613
Program Number: S022
Presentation Session: Bariatric and Metabolic Surgery
Presentation Type: Podium