Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.
Surg Obes Relat Dis. 2020 Nov;16(11):1828-1836. doi: 10.1016/j.soard.2020.06.016. Epub 2020 Jun 17.
Some bariatric procedures have been associated with increased gastroesophageal reflux disease (GERD) symptoms; however, there are limited data on the long-term changes to the esophagus across bariatric procedures, and how preoperative esophageal disease is impacted by bariatric surgery.
To estimate incidence of GERD, esophagitis, Barrett's esophagus, and esophageal adenocarcinoma before and after bariatric surgery and to identify potential risk factors for these conditions.
Retrospective analysis of New York State Database (SPARCS).
Adult patients undergoing bariatric surgery (Roux-en-Y gastric bypass, adjustable gastric banding, laparoscopic sleeve gastrectomy, and biliopancreatic diversion) from 1995 to 2010. Multivariable Cox proportional hazard models were used to examine the association between preoperative diagnosis, surgery type, and postoperative diagnosis.
A total of 48,967 records were analyzed; 30.3% had a diagnosis of GERD at the time of surgery and .4% had a diagnosis of esophagitis and Barrett's. Preoperative GERD/esophagitis/Barrett's was associated with higher risk of GERD, esophagitis, and Barrett's, but not esophageal adenocarcinoma, postoperatively. Roux-en-Y gastric bypass patients had lowest risk of being diagnosed with GERD postoperatively. Overall, esophageal adenocarcinoma incidence in the sample was .04%; the rate among patients with preoperative GERD and Barrett's was .1% and .9%, respectively. Incidence of esophageal adenocarcinoma did not differ by bariatric surgery type.
Preoperative diagnosis is a risk factor for postoperative esophageal disease after bariatric surgery. Adjustable gastric banding and laparoscopic sleeve gastrectomy are associated with higher risk of postoperative GERD and esophagitis compared with Roux-en-Y gastric bypass. Incidence of esophageal adenocarcinoma did not differ by surgery type.
一些减重手术与胃食管反流病（GERD）症状的增加有关；然而，关于减重手术后食管的长期变化以及术前食管疾病如何受到减重手术的影响，数据有限。
评估减重手术后 GERD、食管炎、Barrett 食管和食管腺癌的发生率，并确定这些疾病的潜在危险因素。
纽约州数据库（SPARCS）的回顾性分析。
1995 年至 2010 年间接受减重手术（Roux-en-Y 胃旁路术、可调胃带术、腹腔镜袖状胃切除术和胆胰分流术）的成年患者。多变量 Cox 比例风险模型用于检查术前诊断、手术类型和术后诊断之间的关联。
共分析了 48967 例记录；30.3%的患者在手术时诊断为 GERD，0.4%的患者诊断为食管炎和 Barrett 食管。术前 GERD/食管炎/Barrett 与术后 GERD、食管炎和 Barrett 风险增加相关，但与食管腺癌无关。Roux-en-Y 胃旁路术患者术后诊断 GERD 的风险最低。总体而言，样本中食管腺癌的发病率为 0.04%；术前 GERD 和 Barrett 食管患者的发病率分别为 0.1%和 0.9%。食管腺癌的发生率不因减重手术类型而异。
术前诊断是减重手术后食管疾病的危险因素。与 Roux-en-Y 胃旁路术相比，可调胃带术和腹腔镜袖状胃切除术与术后 GERD 和食管炎的风险增加相关。食管腺癌的发病率不因手术类型而异。
