Case Western Reserve University School of Medicine Cleveland, OH, United States
Alexander M. Hurtado, BA1, Apoorva K. Chandar, MD, MPH2, Kayla Schlick, MS2, Abe Perez, PhD2, Scott A. Martin, MS2, Amitabh Chak, MD2 1Case Western Reserve University School of Medicine, Cleveland, OH; 2University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
Introduction: Bariatric surgery is an effective treatment for obesity and may decrease the morbidity and mortality of obesity associated cancers. However, its protective role against esophageal adenocarcinoma (EAC), and its metaplastic precursor, Barrett’s esophagus (BE) is controversial. We sought to investigate the risk of BE and EAC following bariatric surgery using a large national database.
Methods: A commercial database (TriNetX, Cambridge, MA) that integrates electronic health records from 51 hospital systems comprising over 70 million patients across the United States was analyzed. Cases were adults age ≥ 18 with BMI ≥ 30 who had undergone a bariatric procedure (either sleeve gastrectomy or Roux-en-Y intestinal bypass). Controls comprised of adults age ≥ 18 with BMI ≥ 30 who had never undergone a bariatric procedure. Patients with a prior diagnosis of BE or EAC, and those with a family history of GI malignancy were excluded. Propensity matched cohorts (matched for age, gender, race, smoking history, GERD, proton pump inhibitor [PPI] use, hiatal hernia, obesity, and family history of malignancies) were created using 1:1 greedy nearest neighbor matching. The incidence of BE and/or EAC at least 1 year after bariatric surgery was compared between cases and controls. Odds ratio (OR) and 95% confidence interval (CI) were used to report on these associations for both the unmatched and matched cohorts.
Results: After propensity matching, cases and controls were evenly matched. The average age was 50 years (SD = 13), with a predominance of female (80%), white (69%), obese (55%) patients. About 58% of patients had GERD, while a third were on a PPI. Propensity matching resulted in a sample size reduction from 18,272 (cases) and 306,322 (controls) to 18,269 (cases) and 18,226 (controls). In the unmatched analysis, patients who had undergone a bariatric procedure showed a significantly reduced risk of developing BE/EAC (OR = 0.5; 95% CI = 0.41 - 0.61). This beneficial effect persisted, though slightly attenuated in the propensity matched cohorts (OR = 0.73; 95% CI = 0.57 - 0.94).
Discussion: Propensity-matched analysis demonstrated that patients who received bariatric surgery had a decreased risk of developing BE and/or EAC compared to obese patients who did not receive surgical treatment. The protective mechanisms of bariatric surgery such as favorable shifts in the gut microbiome and changes in gastrointestinal hormonal expression should be investigated.
Figure: Association of Bariatric Surgery with Barrett’s Esophagus and Esophageal Adenocarcinoma
Disclosures: Alexander Hurtado indicated no relevant financial relationships. Apoorva Chandar indicated no relevant financial relationships. Kayla Schlick indicated no relevant financial relationships. Abe Perez indicated no relevant financial relationships. Scott Martin indicated no relevant financial relationships. Amitabh Chak indicated no relevant financial relationships.
Alexander M. Hurtado, BA1, Apoorva K. Chandar, MD, MPH2, Kayla Schlick, MS2, Abe Perez, PhD2, Scott A. Martin, MS2, Amitabh Chak, MD2. P1378 - Bariatric Surgery Protects Against Barrett’s Esophagus and Esophageal Adenocarcinoma: A National Database Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.