Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103, Leipzig, Germany.
Department of Visceral, Thoracic and Vascular Surgery, St. Johann Nepomuk Hospital of Erfurt, Liebigstr. 20, 99097, Erfurt, Germany.
Obes Surg. 2023 Nov;33(11):3391-3401. doi: 10.1007/s11695-023-06829-3. Epub 2023 Sep 30.
Morbid obesity is well known as a risk factor for gastroesophageal reflux disease (GERD) and its related disorders such as Barrett's esophagus (BE). This study aimed to evaluate the development of BE in patients who underwent bariatric surgery.
Using a single-center prospectively established database of obese patients who underwent bariatric surgery from 01/2012 to 12/2019, we retrospectively compared the preoperative endoscopic findings of BE to those after 1-2 years and 3-5 years following bariatric surgery. The change of BE was detected endoscopically according to Prague classification and histologically according to the British guidelines of detecting columnar epithelium on the distal esophagus.
Among 914 obese patients who underwent bariatric surgery and received a preoperative esophagogastroduodenoscopy (EGD), we found 119 patients (13%) with BE. A follow-up EGD was performed in 74 of the BE patients (62.2%). A total of 37 (50%) patients underwent a follow-up EGD after 1-2 years and 45 (60.8%) patients underwent it after 3-5 years. Among many clinical parameters, the surgical procedure was the only significant factor for the change of BE after bariatric surgery (p < 0.05). A regression of BE was found in 19 patients (n = 54, 35%) after laparoscopic Roux-en-Y- gastric bypass (LRYGB). Furthermore, a progression of BE was detected in six patients (n = 20, 30%) after laparoscopic sleeve gastrectomy (LSG).
RYGB should be considered in obese patients with BE. Detecting BE prior to bariatric surgery may have an impact on decision-making regarding the suitable surgical bariatric procedure.
病态肥胖是胃食管反流病（GERD）及其相关疾病（如巴雷特食管（BE））的已知危险因素。本研究旨在评估肥胖患者接受减重手术后 BE 的发展情况。
使用 2012 年 1 月至 2019 年 12 月期间在单中心前瞻性建立的接受减重手术的肥胖患者数据库，我们回顾性比较了 BE 的术前内镜发现与术后 1-2 年和 3-5 年后的内镜发现。BE 的变化通过布拉格分类进行内镜检测，通过英国检测远端食管柱状上皮的指南进行组织学检测。
在 914 例接受减重手术并接受术前食管胃十二指肠镜检查（EGD）的肥胖患者中，我们发现 119 例（13%）患者存在 BE。74 例 BE 患者进行了随访 EGD。共有 37 例（50%）患者在 1-2 年后进行了随访 EGD，45 例（60.8%）患者在 3-5 年后进行了随访。在许多临床参数中，手术方式是减重手术后 BE 变化的唯一显著因素（p<0.05）。在腹腔镜 Roux-en-Y 胃旁路术（LRYGB）后，19 例患者（n=54，35%）的 BE 得到缓解。此外，在腹腔镜袖状胃切除术（LSG）后，6 例患者（n=20，30%）的 BE 进展。
肥胖合并 BE 患者应考虑行 RYGB。减重手术前检测 BE 可能会影响决策是否采用合适的减重手术。
