P2216 - Risk of De Novo Barrett’s Esophagus Post Sleeve Gastrectomy: A Systematic Review and Meta-Analysis

Saurabh Chandan, MD¹, Shahab Khan, MBBS², Smit Deliwala, MD³, Dushyant S. Dahiya, MD⁴, Babu Mohan, MD⁵, Daryl Ramai, MD⁶, Syed Saghir, MD¹, Banreet Dhindsa, MD⁷, Lena Kassab, MD⁸, Antonio Facciorusso, MD, PhD⁹, Kalyana Nandipati, MD¹⁰, Dennis Yang, MD¹¹, Douglas Adler, MD^12
1CHI Health Creighton University Medical Center, Omaha, NE; ²Brigham and Women's Hospital, Boston, MA; ³Emory University, Atlanta, GA; ⁴The University of Kansas School of Medicine, Kansas City, KS; ⁵Orlando Gastroenterology PA, Orlando, FL; ⁶University of Utah School of Medicine, Salt Lake City, UT; ⁷NYU Grossman School of Medicine, New York, NY; ⁸Mayo Clinic, Rochester, MN; ⁹University of Foggia, Foggia, Puglia, Italy; ¹⁰Creighton University School of Medicine, Omaha, NE; ¹¹AdventHealth, Orlando, FL; ¹²Center for Advanced Therapeutic (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO

Introduction: Gastroesophageal reflux disease (GERD), a risk factor for Barrett’s esophagus (BE), is a major concern in patients undergoing Sleeve gastrectomy (SG). In this meta-analysis, we assess the incidence of and analyze predictive factors for post-SG BE.

Methods: A literature search was conducted through April 2024 for studies reporting on incidence of BE, erosive esophagitis (EE) and hiatal hernia (HH) post-SG. Primary outcomes were post-SG pooled rates of de novo BE, EE, GERD symptoms, proton pump inhibitor (PPI) use and HH. Meta-regression analysis was performed to assess if patient and post-SG factors influenced the rates of post-SG BE.

Results: 19 studies with 2046 patients (79% females) were included in the final analysis. The mean age and mean follow-up ranged from 34.8-51 and 2-11.4 years (87.5-1491.7 person years), respectively. Overall, 240 patients were lost to follow up, and 1806 patients were included for post-SG analysis.



The pooled rate (PR) of de novo BE was 5.6% (95% CI 3.5-8.8) from 19 studies. In 3 studies with ≥ 10 years follow up, the PR of de novo BE was 11.6% (95% CI 5.9-21.5; I²72).



The PR of GER/GERD symptoms pre- and post-SG was 14.6% (95% CI 10.6-19.9; I²87) and 48% (95% CI 39.1-57; I²91), respectively. There was a statistically significant increase in the risk of GER/GERD symptoms post-SG, Risk Ratio (RR) 3.32 (95% CI 2.35 - 4.67; I2 78); p< 0.001.



The PR of pre- and post-SG EE was 7.7% (95% CI 4.7-12.5; I²82) and 33.4% (95% CI 26.6-40.9; I²89). There was a statistically significant increase in the risk of EE post-SG, RR 3.37 (95% CI 2.49-4.58; I²48); p< 0.001.



The PR of pre- and post-SG HH was 14.8% (95% CI 9.9-21.4; I²79) and 32.1% (95% CI 21-45.6; I²93). There was a statistically significant increase in the risk of HH post-SG, RR 2.09 (95% CI 1.5-2.9; I2 55); p< 0.001.



The PR of pre- and post-SG PPI use was 13.5% (95% CI 8.9-20; I²75) and 54.6% (95% CI 46.2-62.7; I²87). There was a statistically significant increase in PPI use post-SG, RR 3.65 (95% CI 2.25-5.93; I2 80); p< 0.001.



Based on meta-regression analysis, there was no influence of age, gender, pre- and post-operative BMI, post-procedure HH and EE on PR of post-SG BE. Post-SG GER/GERD had a negative correlation, indicating that incidence of post-SG BE was lower among patients with higher reported GER/GERD.

Discussion: Our analysis shows that SG results in a significantly increased risk of de novo BE and higher rates of EE, PPI use and HH. Hence, clinicians should routinely screen patients with SG for BE.


Disclosures:


Saurabh Chandan, MD¹, Shahab Khan, MBBS², Smit Deliwala, MD³, Dushyant S. Dahiya, MD⁴, Babu Mohan, MD⁵, Daryl Ramai, MD⁶, Syed Saghir, MD¹, Banreet Dhindsa, MD⁷, Lena Kassab, MD⁸, Antonio Facciorusso, MD, PhD⁹, Kalyana Nandipati, MD¹⁰, Dennis Yang, MD¹¹, Douglas Adler, MD¹². P2216 - Risk of De Novo Barrett’s Esophagus Post Sleeve Gastrectomy: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.