scholarly journals Roux-en-Y Gastric Bypass as a Treatment for Barrett’s Esophagus after Sleeve Gastrectomy

2019 ◽  
Vol 30 (4) ◽  
pp. 1273-1279 ◽  
Author(s):  
Daniel M. Felsenreich ◽  
Felix B. Langer ◽  
Christoph Bichler ◽  
Magdalena Eilenberg ◽  
Julia Jedamzik ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Hospital Setting ◽  
University Hospital ◽  
Demeester Score ◽  
The Mean ◽  
Multi Center Study ◽  
Acid Exposure Time

Abstract Background Laparoscopic sleeve gastrectomy (SG) is the most frequently performed bariatric procedure today. While an increasing number of long-term studies report the occurrence of Barrett’s esophagus (BE) after SG, its treatment has not been studied, yet. Objectives The aim of this study was to evaluate Roux-en-Y gastric bypass (RYGB) as treatment for BE and reflux after SG. Setting University hospital setting, Austria Methods This multi-center study includes all patients (n = 10) that were converted to RYGB due to BE after SG in Austria. The mean interval between SG and RYGB was 42.7 months. The follow-up after RYGB in this study was 33.4 months. Gastroscopy, 24 h pH-metry, and manometry were performed and patients were asked to complete the BAROS and GIQLI questionnaires. Results Weight and BMI at the time of SG was 120.8 kg and 45.1 kg/m2. Eight patients (80.0%) went into remission of BE after the conversion to RYGB. Two patients had RYGB combined with hiatoplasty. The mean acid exposure time in 24 h decreased from 36.8 to 3.8% and the mean DeMeester score from 110.0 to 16.3. Patients scored 5.1 on average in the BAROS after conversion from SG to RYGB which denotes a very good outcome. Conclusions RYGB is an effective therapy for patients with BE and reflux after SG. Its outcomes in the current study were BE remission in the majority of cases as well as a decrease in reflux activity. Further studies with larger cohorts are necessary to confirm these findings.

P57 MOTILITY DISORDERS OF THE ESOPHAGUS - A RISK FACTOR FOR THE DEVELOPMENT OF BARRETT'S ESOPHAGUS?

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Knepper Laura ◽  
Bär Anne-Kathrin ◽  
Müller Dolores ◽  
Fuchs Hans ◽  
Fuchs Claudia ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
Esophageal Motility ◽  
Barrett's Esophagus ◽  
Demographic Data ◽  
Motility Disorders ◽  
High Resolution Manometry ◽  
Demeester Score ◽  
Basal Pressure ◽  
Patient Groups ◽  
The Mean

Abstract Aim This study aims to investigate the extent to which esophageal motility affects the development and progression of Barrett's mucosa in GERD patients. Background and Methods The Barret´s esophagus is becoming even more important against the background of an increasing incidence of adenocarcinoma of the esophagus1. The question as to why only a few patients with gastroesophageal reflux disease (GERD) develop a Barrett's esophagus has not been clarified. A cohort of 315 GERD patients with and without Barrett's esophagus who received High Resolution Manometry (HRM) as part of their regular diagnostics was therefore examined in this study. The evaluation of the HRM results was based on the Chicago classification version 3.02 and was compared with endoscopic and histological findings. Results Out of the 315 GERD patients, 67 had a Barrett's esophagus. The two patient groups (GERD without Barrett and GERD with Barrett) did not differ in demographic data and risk profile (hiatal hernia 71.4% vs 10.2%). In pH metry, both groups achieved a comparable DeMeester score as well as a similar fraction time (49.6 vs 44.2, 13% vs 11.7%). In both groups, approximately 40% of patients showed motility disorders. The mean basal pressure and the mean DCI also showed comparable values (21.2 vs 21.3, 1189.2 vs 1249.2). However, when comparing patients within the Barrett cohort with a long and a short segment Barrett (LSB, SSB), differences in peristalsis and pressure build-up of the distal esophagus become clear. Patients with an LSB showed a lower basal pressure of the lower esophageal sphincter (LES) and lower mean DCI (12.9 vs 25.0, 1230.0 vs 1389.3). In addition, they presented a hypotonic LES more frequently (54.6% vs 17.4%). Patients with LSB also showed motility disorders more often (54.6 vs 39.1), especially ineffective motility and fragmented peristalsis (18.2% vs 10.9%, 9.1% vs 2.2%). Conclusion The differences in motility disorders between Barrett and non-Barrett patients already described in other publications3 could not be confirmed in this study, despite the large cohort of 315 patients. However, the differences between LSB and SSB patients suggest that esophageal motility disorders can at least influence the severity of this disease.

Comments on Roux-en-Y Gastric Bypass as a Treatment for Barrett’s Esophagus After Sleeve Gastrectomy

2020 ◽  
Vol 30 (6) ◽  
pp. 2415-2416
Author(s):  
Marine Guingand ◽  
Veronique Vitton ◽  
Marc Barthet ◽  
Jean-Michel Gonzalez
Keyword(s):  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus

Predictive value of preoperative DeMeester score on conversion to Roux-en-Y gastric bypass for gastroeosophageal reflux disease after sleeve gastrectomy

2020 ◽  
Vol 16 (9) ◽  
pp. 1219-1224 ◽  
Author(s):  
Marie De Montrichard ◽  
Tristan Greilsamer ◽  
David Jacobi ◽  
Stanislas Bruley des Varannes ◽  
Eric Mirallié ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Reflux Disease ◽  
Predictive Value ◽  
Demeester Score

Significantly lower annual rates of neoplastic progression in short- compared to long-segment non-dysplastic Barrett’s esophagus: a systematic review and meta-analysis

Endoscopy ◽  
2019 ◽  
Vol 51 (07) ◽  
pp. 665-672 ◽  
Author(s):  
Viveksandeep Thoguluva Chandrasekar ◽  
Nour Hamade ◽  
Madhav Desai ◽  
Tarun Rai ◽  
Venkata Subhash Gorrepati ◽  
...  
Keyword(s):  
Systematic Review ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Neoplastic Progression ◽  
Number Of Patients ◽  
The Mean ◽  
Surveillance Endoscopy

Abstract Background Although shorter lengths of Barrett’s esophagus (BE) have been associated with a lower risk of neoplastic progression, precise estimates have varied, especially for non-dysplastic BE (NDBE) only. Therefore, current US guidelines do not provide specific recommendations on surveillance intervals based on BE length. We performed a systematic review and meta-analysis of the published literature to examine neoplastic progression rates of NDBE based on BE length. Methods PubMed, Cochrane, Google Scholar, and Embase were comprehensively searched. Studies reporting progression rates in patients with NDBE and > 1 year of follow-up were included. The number of patients progressing to esophageal adenocarcinoma (EAC) and high grade dysplasia (HGD)/EAC in individual studies and the mean follow-up were recorded to derive person-years of follow-up. Pooled rates of progression to EAC and HGD/EAC based on BE length (< 3 cm vs. ≥ 3 cm) were calculated. Results Of the 486 initial studies identified, 10 met the inclusion/exclusion criteria. These included a total of 4097 NDBE patients; 1979 with short-segment BE (SSBE; 10 773 person-years of follow-up) and 2118 with long-segment BE (LSBE; 12 868 person-years). The annual rates of progression to EAC were significantly lower for SSBE compared with LSBE: 0.06 % (95 % confidence interval 0.01 % – 0.10 %) vs. 0.31 % (0.21 % – 0.40 %), respectively; odds ratio (OR) 0.25 (0.11 – 0.56); P < 0.001, as were the rates for the combined endpoint (HGD/EAC): 0.24 % (0.09 % – 0.32 %) vs. 0.76 % (0.43 % – 0.89 %), respectively; OR 0.35 (0.21 – 0.58); P < 0.001. There was no significant heterogeneity among studies. Conclusion The results demonstrate significantly lower rates of neoplastic progression in NDBE patients with SSBE compared with LSBE. BE length can easily be used for risk stratification purposes for NDBE patients undergoing surveillance endoscopy and consideration should be given to tailoring surveillance intervals based on BE length in future US guidelines.

Reply to Letter Regarding “Barrett’s esophagus and Sleeve Gastrectomy”

2019 ◽  
Vol 29 (12) ◽  
pp. 4064-4065
Author(s):  
Antonio Iannelli ◽  
Sébastien Frey ◽  
Lionel Sebastianelli ◽  
Antonella Santonicola ◽  
Mirto Foletto ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus

Lack of Correlation Between Subjective and Objective Measures of Gastroesophageal Reflux Disease: Call for a Novel Validated Assessment Tool

2020 ◽  
pp. 155335062095503
Author(s):  
Brittany L. Kothari ◽  
Andrew J. Borgert ◽  
Kara J. Kallies ◽  
Shanu N. Kothari
Keyword(s):  
Quality Of Life ◽  
Gastroesophageal Reflux Disease ◽  
Exposure Time ◽  
Acid Exposure ◽  
Objective Measures ◽  
Demeester Score ◽  
Related Quality ◽  
The Mean ◽  
Acid Exposure Time

Background. Objective measures including the DeMeester score, lower esophageal sphincter (LES) pressure, acid exposure time, and body mass index (BMI) are used to determine gastroesophageal reflux disease (GERD) severity and eligibility for various antireflux surgical procedures. The GERD Health-Related Quality of Life (GERD-HRQL) survey is widely used to evaluate patients’ subjective severity of symptoms and GERD-related quality of life. The purpose of this project was to identify whether or not the subjective measure (GERD-HRQL) correlated with objective measures (DeMeester score, LES, acid exposure time, and BMI) of GERD severity. Methods. A retrospective review of the medical records of patients who underwent antireflux surgery from 2013-2018 was completed. Patients’ GERD severity was measured preoperatively and postoperatively using the GERD-HRQL. Statistical analysis included the calculation of Spearman correlation coefficients, Wilcoxon rank sum, sign, and chi-square tests. Results. 151 patients were included in the study; 64% were female. The mean age and BMI were 54.6 ± 14.6 years and 30.1 ± 4.1 kg/m2, respectively. The mean preoperative DeMeester score was 43.1 ± 36.1, LES pressure was 19.9 ± 18.4 mmHg, and acid exposure time was 11.4 ± 9.6. Mean GERD-HRQL scores decreased from 27.3 ± 9.2 preoperative to 5.3 ± 4.5 postoperative; P < .0001. Preoperative GERD-HRQL scores were not correlated with the DeMeester score ( r = .11; P = .389), LES pressure ( r = −.20; P = .089), acid exposure time ( r = .05; P = .755), BMI ( r = .10; P = .329), or age ( r = −.16; P = .118). Conclusions. Total GERD-HRQL scores significantly decreased from pre- to postoperative. There was no correlation between subjective and objective GERD scoring. These data indicate the need for both physiologic evaluation and subjective assessment of patient symptoms during preoperative workup. There is a need for a contemporary, validated GERD questionnaire that correlates with objective pH testing.

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