Gastroesophageal Reflux is Common After Both Sleeve and Band; GER is Precancerous Lesion; a Warning to Surgeons and Patients: the Band and Sleeve May Lead to GER and Esophageal Cancer

R Rutledge, MD

Center for Laparoscopic Obesity Surgery

The Link between gastroesophageal reflux (GER) and esophageal cancer is undeniable. “There is a strong and causal relation between gastroesophageal reflux and esophageal adenocarcinoma.”(1) Hundreds of other studies support this conclusion.

Therefore an intervention that significantly increases the rate and severity of GER can be predicted to increase the frequency of esophageal cancer.

To study this phenomenon we performed a survey of 112 internationally recognized experts on bariatric surgery to determine their experiences and judgment related to the development of GER following Sleeve and Band

Results
112 surgeons with experience in over 39,000 cases from 23 countries responded.
89% of surgeons reported that “GE Reflux / Nausea & Vomiting is Common” and 55.4% of surgeons agreed that “GE Reflux / Nausea & Vomiting is Common” after sleeve gastrectomy.

When presented with this question: “GERD Increases Risk of Cancer of Esophagus. Longer GERD = More Risk. GERD can cause Barrett’s = even higher risk,” from the American Cancer Society.

With the reference for this quote provided (2): 88.9% of surgeons Agreed but remarkably 11% disagreed? The 11% that disagreed were more likely supporters of the Band and the Sleeve, (Good or Adequate surgery 42.9% and 85.8% respectively)

When presented with question “Numerous Studies Now Show that the Band and the Sleeve can increase acid reflux and be associated with Barretts.”

With these 5 quoted references (3-7) remarkably 21.7% Disagree!

When asked for quantitative data on the incidence of GER after Band or Sleeve, we asked what is the “Postop GE Reflux rate (%)” in Band patients. The surgeons reported that 26.5%, over one quarter of Band patients, suffer GER post op and importantly this is an increase from less than 10% reported with GER preop. In Sleeve patients surgeons reported that the Pre op GE Reflux rate (%) was 8% and post op increased to 27.7%

Conclusions: Although some band and sleeve surgeons may not agree GER is a recognized precursor to esophageal cancer. In addition this survey data confirms other publications that these restrictive and obstructive procedures lead increase of GER in at least 25% of patients. In one study chronic daily reflux symptoms was associated with a 44 fold increase in risk of esophageal cancer. It appears that Sleeve and Band surgeons should warn their patients of the long term risk of GER and esophageal cancer.

(1) Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med. 1999 Mar 18;340(11):825-31.
(2) JAMA. 2002 Gastroesophageal reflux, Barrett esophagus, and esophageal cancer. Shaheen N, Ransohoff DF.
(3) Ca.Dis Esoph. 2011 Esophageal adenocarcinoma after laparoscopic gastric band Stauffer et.al..
(4) Ann Surg. 2010 Long-term results of laparoscopic sleeve gastrectomy Himpens J
(5) Obes Facts. 2011; Failure of laparoscopic sleeve gastrectomy Weiner RA, et.al.
(6) Surg Obes Relat Dis. 2011 Gastroesophageal reflux after sleeve gastrectomy Howard D
(7) Obes Surg. 2010 Barrett’s esophagus: a late complication of laparoscopic adjustable gastric banding, Varela J


Session: Poster Presentation

Program Number: P149

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