The Band and the Sleeve as Pre-Cancerous Procedures; the Band and the Sleeve Cause Gastroesophageal Reflux (GER); Gastroesophageal Reflux Causes Esophageal Cancer

R Rutledge, MD

The Centers for Laparoscopic Obesity Surgery

The Sleeve and the Band are popular and certified restrictive procedure for weight loss. Numerous studies show that Gastroesophageal Reflux (GER) is growing problem following the Band and the sleeve.

– Vaughn et.al. (1) showed that the risk of esophageal adenocarcinoma increased with frequent GERD symptoms; the odds ratio in those reporting daily symptoms was 5.5.

– Lagergren J et.al. (2) showed that “among persons with long-standing and severe symptoms of reflux, the odds ratios were 44 (95 % c.i. 18 to 100) for esophageal adenocarcinoma.”

Studies reporting a growing rate of GER with the band and sleeve include:

– Leblanc (3) showed that 47.2% had persistent GERD symptoms.
– Weiner (4) showed that 15% of sleeve patients had severe gastroesophageal reflux requiring conversion to RNY.
– Gutchow (5) performed Upper gastrointestinal endoscopy patients after 30.1 months (range, 5-67 months), showing a high prevalence of esophagitis (30.0%).
– Himpens (6) showed that GERD occurred after 1 year in 22% of patients with Sleeve and after 3 years in 21% of patients with the Band.

Finally several cases of esophageal cancer after Band have been reported.

Conclusions:
1 Acid reflux unequivocally has been shown to be “a strong causative factor in esophageal cancer.”
2. Restrictive procedures (sleeve and band) cause increasing rates of gastroesophageal reflux over time of follow up.
3. Not unexpectedly, cases of esophageal cancer are being reported after the band.
4. Surgeons should consider warning their band and sleeve patients that the band and the sleeve may result in esophageal cancer.

(1) Gastroesophageal reflux disease and risk of esophageal cancer.Farrow DC, Vaughan TL, Cancer Causes Control. 2000 Mar;11(3):231-8.
(2) Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden. jesper.lagergren@mep.ki.se N Engl J Med. 1999 Mar 18;340(11):825-31.
(3) Surg Obes Relat Dis. 2011 Sep-Oct;7(5):569-72. Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Carter PR, LeBlanc KA, Hausmann MG, Kleinpeter KP, deBarros SN, Jones SM. Midwest Surgical Associates, 5201 South Willow Springs Road, Suite 180, LaGrange, IL 60304, USA. doctorpcarter@yahoo.com
(4) Obes Facts. 2011;4 Suppl 1:42-6. Failure of laparoscopic sleeve gastrectomy–further procedure? Weiner RA, Theodoridou S, Weiner S. Department of Surgery, Krankenhaus Sachsenhausen, Frankfurt/M, Germany. rweiner@khs-ffm.de
(5) J Gastrointest Surg. 2005 Sep-Oct;9(7):941-8.Long-term results and gastroesophageal reflux in a series of laparoscopic adjustable gastric banding. Gutschow CA, Collet P, Prenzel K, Hölscher AH, Schneider PM.
(6) Obes Surg. 2006 Nov;16(11):1450-6. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Himpens J, Dapri G, Cadière GB.


Session: Posters/Distinction

Program Number: P003

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