S1200 Roux-En-Y Gastric Bypass Is Associated With Higher Rates of Barrett’s Esophagus and Esophageal Adenocarcinoma When Compared to Laparoscopic Sleeve Gastrectomy: Findings of a Nationwide Analysis With Long-Term Follow-Up

Abstract

INTRODUCTION: Obesity is thought to be a risk factor for esophageal malignancy. The association between bariatric interventions and esophageal malignancy remains unclear. We aim to examine the rates of Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC) in obese patients and in those who underwent roux-en-y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB). METHODS: A commercial database (Explorys Inc, Cleveland, OH, USA), consisting of EHR data from 26 US healthcare systems, was surveyed. After excluding bariatric surgery, a cohort of patients with Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) diagnosis of obesity (1999–2020) was identified. Within the obesity cohort, patients who developed new diagnoses of BE and EAC were identified. Subsequently, several cohorts of patients who underwent RYGB, LSG and LAGB were identified. The rates of new diagnoses of BE and EAC after at least 30 days of RYGB, LSG or LAGB were calculated. Risks were compared using univariable analysis. RESULTS: Of 72,531,460 patients in the database, 4,699,470 (6.5%), 230,300 (0.31%), and 10,950 (0.02%) with obesity, BE and EAC were identified respectively. There were 24,630 (0.03%) RYGB, 32,360 (0.05%) LSG and 8,650 (0.01%) LAGB. A total of 240 (0.97%), 110 (0.34%) and 70 (0.81%) of BE were identified after at least 30 days of RYGB, LSG and LAGB. A total of 20 (0.08%), 5 (0.02%), and 5 (0.06%) of EAC cases were identified after at least 30 days of RYGB, LSG and LAGB. Patients who underwent RYGB were more likely to develop BE and EAC when compared to patients who underwent LSG. Patients who underwent LSG were less likely to develop BE when compared to obese patients (Table 1). History of baseline GERD (prior to surgery) and cholecystectomy were associated with increased risk of BE after surgery (Table 2). Prevalence rates of BE over time after surgery are presented in Figure 1. CONCLUSION: Explorys rounds to the closest 0 or 10 to protect patient identity. This did not allow for further analysis of EAC. There is also potential selection and confounding biases. However, this is the largest study to evaluate the risk of BE and EAC in RYGB, LSG and LAGB. RYGB patients had higher risks of BE and EAC when compared to LSG. Longer duration of GERD in the RYGB population prior to surgery may explain this finding. The significant anatomical alteration and physiological changes may also contribute to these findings.Table 1.: Risk of Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC) in roux-en-y gastric bypass (RYGB) vs. obesity (no bariatric surgery), RYGB vs. laparoscopic sleeve gastrectomy (LSG), RYGB vs. laparoscopic adjustable gastric banding (LAGB), LSG vs. obesity (no bariatric surgery), LSG vs. LAGB, and LAGB vs. obesity (no bariatric surgery). *P-value not significantTable 2.: Underlying risk factors of Barrett’s esophagus (BE) after roux-en-y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB). *P-value not significantFigure 1.: Prevalence of Barrett’s esophagus (BE) after roux-en-y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) over a 10 year follow up. *Explorys rounds to the nearest zero or 1.