Risk of De Novo Barrett’s Esophagus Post Sleeve Gastrectomy: A Systematic Review and Meta-Analysis of Studies with Long-Term Follow-Up

Abstract

Sleeve gastrectomy (SG) is one of the most commonly performed bariatric procedures worldwide. Gastroesophageal reflux disease (GERD) is a major concern in patients undergoing SG and is a risk factor for Barrett's esophagus (BE). We conducted a systematic review and meta-analysis to assess the incidence of and analyze predictive factors for post-SG BE. A comprehensive literature search was conducted in April 2024, for studies reporting on incidence of BE, erosive esophagitis (EE) and hiatal hernia (HH) post SG. Primary outcomes were post SG pooled rates of de novo BE, EE, GERD symptoms, proton pump inhibitor (PPI) use and HH. Meta-regression analysis was performed to assess if patient and post SG factors influenced the rates of post SG BE. Nineteen studies with 2046 patients (79% females) were included. Mean age was 42.2 years (SD 11.1) and follow up ranged from 2 to 11.4 years. The pooled rate of de novo BE post SG was 5.6% (CI 3.5-8.8). Significantly higher pooled rates of EE [Risk Ratio (RR) 3.37], HH [RR 2.09], GER/GERD symptoms [RR 3.32] and PPI use [RR 3.65], were found among patients post SG. GER/GERD symptoms post SG positively influenced the pooled BE rates, while age, sex, BMI, post SG EE and HH did not. Our analysis shows that SG results in a significantly increased risk of de novo BE and higher rates of EE, PPI use and HH. Our findings suggest that clinicians should routinely screen patients with SG for BE and future surveillance intervals should be followed as per societal guidelines.