Division of Minimally Invasive and Metabolic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Surgery, Centra Medical Group, 1911 Thomson Dr, Lynchburg, VA, 24501, USA.
Surg Endosc. 2018 Feb;32(2):930-936. doi: 10.1007/s00464-017-5768-6. Epub 2017 Aug 4.
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 very little 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 duodeno-gastro-esophageal reflux should lead to decreased BE. In this study we examine the effect of LRYGB on regression of BE.
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 was identified who had at least 1 year of clinical, endoscopic, or histological data, comprising a total of 14 patients. Seven of these patients had symptoms of gastroesophageal reflux. All 19 patients had short-segment BE. One patient had low-grade dysplasia.
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 to 30.3 kg/m.
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.
巴雷特食管（BE）与肥胖和代谢综合征有关。腹腔镜胃旁路手术（LRYGB）可能是一种既能解决严重肥胖问题又能解决 BE 的手术方法。由于 Roux 袢较长，LRYGB 会使胆汁远离胃袋和食管，而基于贲门的胃袋中几乎不会产生胃酸。此外，手术引起的体重减轻可能会减轻全身炎症，这可能有助于食管的化生变化。此外，由于参加了减肥计划，患者对质子泵抑制剂治疗的依从性提高，从而进一步减少胃酸的产生。减少十二指肠胃食管反流应该会导致 BE 减少。在这项研究中，我们研究了 LRYGB 对 BE 消退的影响。
我们对在我们机构接受 LRYGB 治疗并经活检证实为 BE 的所有患者进行了回顾性研究。共确定了 19 名患者。从这些患者中确定了一部分至少有 1 年临床、内镜或组织学数据的患者，共 14 名患者。其中 7 名患者有胃食管反流症状。所有 19 名患者均有短段 BE。1 名患者有低级别异型增生。
LRYGB 后，14 名患者中有 6 名（42.9%）患者的 BE 组织学消退至正常食管黏膜，无持续 BE 证据。14 名患者中有 13 名（92.8%）报告在手术后至少第一年继续服用 PPI 治疗的依从性。14 名患者的体重指数从 46.6 降至 30.3kg/m。
我们建议 LRYGB 作为一种有效的减肥和抗反流手术方法，用于治疗严重肥胖和 BE 的患者。在短期随访中，我们系列中的许多患者的 LRYGB 实现了内镜和组织学消退至正常黏膜。仍建议根据标准监测方案对 BE 患者进行长期随访。
