Impact of bariatric surgery on surveillance and treatment outcomes of Barrett’s esophagus: A stage-matched cohort study

Background Obesity could increase the risk of Barrett’s esophagus (BE). Roux-en-Y gastric bypass (RYGB) could alter the natural course of BE. Data on BE progression after RYGB is scarce. Objectives To study endoscopic surveillance and endoscopic eradication therapy (EET) outcomes of BE in post-RYGB patients versus obese controls. Setting Academic referral centers, a retrospective cohort study. Methods Patients who underwent RYGB with biopsy-proven BE or intramucosal esophageal adenocarcinoma (IM-EAC) with an endoscopic follow-up of at least 12 months were identified from a prospectively maintained database between January 1992 and February 2019 at three tertiary care centers. RYGB patients were matched one-to-two to obese patients (body mass index > 30 kg/m2) by the initial BE stage at diagnosis. Surveillance and EET outcomes were compared. Results A total of 147 patients were included (49 RYGB and 98 BE stage-matched obese controls). For endoscopic surveillance, the rate of disease progression to high-grade dysplasia (HGD)/IM-EAC was significantly lower in the RYGB patients than controls (2.6% vs. 40.2%, P Conclusion RYGB appears to be a protective factor for disease progression to neoplastic BE during endoscopic surveillance. However, disease progression was still observed after RYGB warranting continuing surveillance endoscopy. EET appeared to be equally effective between RYGB and obese groups.