Department of Surgery, Central Clinical School, Monash University, Prahran, Victoria, Australia.
Department of Upper Gastrointestinal and Hepatobiliary Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia.
Ann N Y Acad Sci. 2020 Dec;1481(1):224-235. doi: 10.1111/nyas.14441. Epub 2020 Aug 13.
Obesity is a strong risk factor for Barrett's esophagus (BE), the only proven precursor lesion to esophageal adenocarcinoma (EAC). Bariatric surgery is currently the only reliable treatment that achieves long-term sustained weight loss; however, it can markedly affect the development of de novo BE, and the progression or regression of existing BE. Bariatric procedures may also have implications on future surgical management of any consequent EAC. In this review, we examine the current evidence and published guidelines for BE in bariatric surgery. Current screening practices before bariatric surgery vary substantially, with conflicting recommendations from bariatric societies. If diagnosed, the presence of BE may alter the type of bariatric procedure. A selective screening approach prevents unnecessary endoscopy; however, there is poor symptom correlation with disease. Studies suggest that sleeve gastrectomy predisposes patients to gastroesophageal reflux and de novo BE. Conversely, Roux-en-Y gastric bypass is associated with decreased reflux and potential improvement or resolution of BE. There are currently no guidelines addressing the surveillance for BE following bariatric surgery. BE is an important consideration in the management of bariatric surgical patients. Evidence-based recommendations are required to guide procedure selection and postoperative surveillance.
肥胖是 Barrett 食管（BE）的一个强烈危险因素，BE 是食管腺癌（EAC）唯一被证实的前体病变。减重手术目前是实现长期持续减重的唯一可靠治疗方法；然而，它会显著影响新发 BE 的发展，以及现有 BE 的进展或消退。减重手术还可能对随后发生的任何 EAC 的手术治疗产生影响。在这篇综述中，我们检查了减重手术中 BE 的现有证据和已发表的指南。减重手术前的 BE 筛查实践差异很大，减重协会的建议也相互矛盾。如果诊断出 BE，可能会改变减重手术的类型。选择性筛查方法可以防止不必要的内镜检查；然而，症状与疾病的相关性较差。研究表明，胃袖状切除术使患者易患胃食管反流和新发 BE。相反，Roux-en-Y 胃旁路术与反流减少相关，并且可能改善或消除 BE。目前尚无指南针对减重手术后 BE 的监测。BE 是管理减重手术患者时需要考虑的一个重要因素。需要循证建议来指导手术选择和术后监测。
