Abstract
The hypothesis that sleeve gastrectomy (SG) is not associated with an increase in mucosal colorectal cancer (CRC) biomarkers, unlike Roux-en-Y gastric bypass (RYGB), was tested. Rectal mucosa, blood, and urine were obtained from morbidly obese patients (n = 23) before and after (median 28 months) SG, as well as from nonobese controls (n = 20). Rectal epithelial cell mitosis and apoptosis, crypt size/fission, and pro-inflammatory gene expression were measured, as well as systemic inflammatory biomarkers, including C-reactive protein (CRP). The mean pre-operative body mass index in SG patients was 65.7 kg/m2 (24.7 kg/m2 in controls). Mean excess weight loss post-SG was 38.2%. There was a significant increase in mitosis frequency, crypt size, and crypt fission (all P < 0.01) in SG patients versus controls, as well as evidence of a chronic inflammatory state (raised CRP and mononuclear cell p65 NFκB binding), but there was no significant change in these biomarkers after SG, except CRP reduction. Macrophage migration inhibitory factor mRNA levels were increased by 39% post-SG (P = 0.038). Mucosal biomarkers of CRC risk do not increase at 6 months following SG, unlike RYGB. Biomarkers of rectal crypt proliferation and systemic inflammation are increased in morbidly obese patients compared with controls.
Highlights
The number of bariatric surgical procedures that are performed continues to increase in line with the increasing global prevalence of obesity (1,2)
In a large population-based study in Sweden, we recently reported that the standardized incidence ratio (SIR) for colorectal cancer (CRC) risk increased with time after bariatric surgery such that the SIR was 2 (95%confidence interval (CI) 1.5-2.6) 10 years after surgery compared with a SIR of 1.25 for a group of obese patients who did not undergo bariatric surgery, which remained stable over time (8)
Between October 2008 and July 2010, 23 out of 35 potential Sleeve gastrectomy (SG) patients consented to participate in the study and provide blood, urine, and rectal mucosal samples
Summary
The number of bariatric surgical procedures that are performed continues to increase in line with the increasing global prevalence of obesity (1,2). Initial reports suggested that bariatric surgery was associated with a reduction in overall cancer risk and risk associated with some obesity-related cancers including postmenopausal breast cancer (5-7) These studies were too small to determine specific effects on CRC risk. The increased CRC SIR was shared by those who underwent restrictive procedures (limited to gastric banding and vertical-band gastroplasty), as well as the more common RYGB (8). These observational findings concurred with our previous colorectal mucosal biomarker studies, in which a mucosal hyper-proliferative state (increased epithelial cell mitosis frequency and crypt size) persisted at least three years after RYGB compared with pre-operative morbidly obese patients and normal weight controls (9,10)
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