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INCIDENCE OF GERD, ESOPHAGITIS, BARRETT's ESOPHAGUS, AND ESOPHAGEAL ADENOCARCINOMA ACROSS BARIATRIC PROCEDURE TYPES
Lisa A. Bevilacqua*1, Nabeel R. Obeid2, Jie Yang3, Chencan Zhu3, Konstantinos Spaniolas1, Aurora D. Pryor1
1Surgery, Stony Brook University School of Medicine, Port Jefferson, NY; 2Surgery, University of Michigan, Ann Arbor, MI; 3Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY
Introduction. Obesity is an independent risk factor for gastroesophageal reflux disease (GERD) and has been implicated in the rising incidence of esophageal adenocarcinoma (EAC). Some bariatric procedures (adjustable gastric banding [AGB] and laparoscopic sleeve gastrectomy [LSG]) have been implicated to increase GERD symptoms. Conversely, Roux-en-Y gastric bypass (RYGB) consistently improves symptomatic GERD in patients undergoing bariatric surgery. However, there is limited data on the long-term changes to the esophagus across bariatric procedures. The purpose of this study was to investigate the long-term incidence of GERD, esophagitis, Barrett's esophagus (BE), and EAC across multiple types of bariatric surgery.
Methods. Retrospective review of a prospectively collected statewide database (SPARCS) was done for all patients ≥18 years undergoing bariatric surgery (biliopancreatic diversion [BPD], AGB, LSG, RYGB) from 1995-2010. Welch's test with unequal variance was used to examine the marginal association between time to diagnosis and surgery type. Chi-square tests were utilized to examine the association between bariatric surgery type and post-op diagnosis.
Results. A total of 48,991 records were analyzed. Mean age was 42.83 years (SD=11.33). The majority of the sample was female (78.42%) and Caucasian (61.26%). Patients with GERD at the time of surgery had higher odds of GERD (OR=2.19, 95% CI: 2.09-2.29), esophagitis (OR=1.37, 95% CI: 1.25-1.51), and BE (OR=2.01, 95% CI: 1.71-2.37 after surgery. Similarly, patients with BE at the time of surgery had higher odds of GERD (OR=1.98, 95% CI: 1.35-2.89), esophagitis (OR=3.17, 95% CI: 1.84-5.48), and BE (OR=45.18, 95% CI: 30.4-67.14) after surgery. GERD-related diagnoses were common before surgery: 30.08% GERD alone, 0.12% esophagitis, and 0.24% BE. Patients with no GERD related diagnosis at baseline were significantly less likely to develop GERD (OR 0.62 and 0.61 compared to AGB and LSG respectively) and esophagitis (OR 0.52 and 0.62 compared to AGB and LSG, respectively) following RYGB. We found an overall postoperative incidence EAC of 0.043%. This was only slightly lower among patients without any preoperative diagnoses (0.038%). The incidence of EAC did not differ by type of bariatric surgery performed.
Conclusions. Preoperative GERD is a risk factor for postoperative esophageal disease (GERD, esophagitis, BE) in patients undergoing bariatric surgery. AGB and LSG were more likely to be associated with the development of GERD and esophagitis compared to RYGB. The overall incidence of EAC in the bariatric surgery population is low, and there was no significant difference in the incidence of EAC in this study period.
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