University of Florida Gainesville, FL, United States
Bashar Qumseya, MD1, Yazan Qumsiyeh, MD2, Ahmed Saheed, MD1, Robyn Rosasco, MS3, Amira Qumseya, MS, MBA1 1University of Florida, Gainesville, FL; 2University of California, Fresno, CA; 3Florida State University, Tallahassee, FL
Introduction: Barrett’s esophagus is a relative contraindication for Sleeve gastrectomy, but not for Roux-en-Y gastric bypass (RNY). However, studies assessing the effect of RNY on BE are limited. Therefore, we aimed to conduct a systematic review and meta-analysis of studies of obese patients who also had BE and underwent RNY.
Methods: We conducted a systematic review using MEDLINE (Ovid), Web of Science, Embase, Cochrane Library and CENTRAL, and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) from inception to January 8th, 2021. The primary outcome of interest was the rate of BE resolution of RNY. This was reported as a proportion with 95% CI. The primary effect estimate was reported at a proportion with 95% confidence intervals (CI). Heterogeneity was assessed by funnels plots and the classic fail-test. Forest plots were used to report pooled effect estimates. Heterogeneity was assessed using I2 and p-value.
Results: The final search included 4,389 citations. Of these 9 were included in the final analysis. These included 7 manuscripts and 2 recent meeting abstracts. Mean BE length before surgery varied from < 2 to 6 cm. A total 104 patients, including 9 with dysplasia, had BE and underwent RNY. On follow up endoscopy post-surgery, 53 of them were noted to have remission of BE. On random effect modeling, the rate of complete remission of intestinal metaplasia (CRIM) was 50% [95%CI: 40 – 61%], p=0.937 (figure 1), I2=4.6%, Q=8.4, p=0.396. The pooled rate of BE improvement was reported in 4 studies and found to be 52% [95%CI: 37 – 66%], p=0.8, I2=16.5%, Q=4.8, p=0.31. The pooled rate of no change in 5 studies was 40% [95%CI: 24– 58%], p=0.265, I2=18.7%, Q=4.9, p=0.296. In four studies, complete remission of dysplasia (CRD) was also reported in 4 of 6 patients.
Discussion: Thought data is limited, the majority of patient with BE who underwent RNY for weight loss had remission or improvement in BE on follow up endoscopy. This is reassuring for obese patient with BE.
Figure: Figure 1: Forest plot of the 9 studies showing remission of Barrett's Esophagus post gastric bypass
Bashar Qumseya indicated no relevant financial relationships.
Yazan Qumsiyeh indicated no relevant financial relationships.
Ahmed Saheed indicated no relevant financial relationships.
Robyn Rosasco indicated no relevant financial relationships.
Amira Qumseya indicated no relevant financial relationships.
Bashar Qumseya, MD1, Yazan Qumsiyeh, MD2, Ahmed Saheed, MD1, Robyn Rosasco, MS3, Amira Qumseya, MS, MBA1. P1354 - High Rates of Regression of Barrett’s Esophagus in Obese Patient Post Roux-en-Y Gastric Bypass: Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.