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Barrett’s Esophagus in Obese Patient Post-Roux-en-Y Gastric Bypass: a Systematic Review

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Abstract

Purpose

Barrett’s esophagus (BE) 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. We aimed to conduct a systematic review and meta-analysis of studies of obese patients who also had BE and underwent RNY.

Materials and Methods

We conducted a systematic review of literature using multiple search engines from inception to January 2021. The primary outcome of interest was the rate of BE resolution post-RNY. This was reported as a proportion with 95% confidence intervals (CI). Publication bias 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 4389 citations, 16 were reviewed in full text, and 9 were included in the final analysis, including 7 manuscripts and 2 recent meeting abstracts. In the 9 studies, 104 patients had BE and underwent RNY. On random effect modeling, the rate of complete remission of intestinal metaplasia (CRIM) was 50% [95%CI: 40–61%], p = 0.937, I2 = 4.6%, Q = 8.4, p = 0.396. The pooled rate of BE improvement was 52% [95%CI: 37–66%], p = 0.8, I2 = 16.5%, Q = 4.8, p = 0.31. Complete remission of dysplasia (CRD) was also reported in 4 of 6 patients.

Conclusion

Despite the limited data, a majority of patient with BE who underwent RNY for weight loss had remission or improvement in BE on follow-up endoscopy. However, a significant minority had no change to BE on follow-up.

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Abbreviations

BE:

Barrett’s esophagus

SIM:

Specialized intestinal metaplasia

LGD:

Low-grade dysplasia

EAC:

Esophageal adenocarcinoma

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

CI:

Confidence interval

CRIM:

Complete remission of intestinal metaplasia

CRD:

Complete remission of dysplasia

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Author information

Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, University of Florida, 1329 SW 16th St., Gainesville, FL, 32610, USA

    Bashar Qumseya

  2. Department of Surgery, University of California San Francisco - Fresno, Fresno, CA, 93701, USA

    Yazen Qumsiyeh

  3. Department of Medicine, University of Florida, Gainesville, FL, 32610, USA

    Ahmed Sarheed

  4. Florida State University, Tallahassee, FL, 32312, USA

    Robyn Rosasco

  5. Department of Public Health, University of Florida, Gainesville, FL, 32608, USA

    Amira Qumseya

Authors
  1. Bashar Qumseya
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  2. Yazen Qumsiyeh
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  3. Ahmed Sarheed
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  4. Robyn Rosasco
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  5. Amira Qumseya
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Contributions

Conception and design: B. Q.

Analysis and interpretation of data: B. Q., A. Q.

Drafting of the article: B. Q.

Critical revision of the article for important intellectual content: all authors

Final approval of the article: all authors

Corresponding author

Correspondence to Bashar Qumseya.

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Ethics Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent does not apply.

Conflict of Interest

Dr. Qumseya is a consultant for Medtronic and Assertio Management and a speaker for Castle Biosciences.

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Key Points

• Meta-analysis to assess rate of BE resolution post-RNY.

• Majority of patient with BE who underwent RNY for weight loss had remission or improvement in BE on follow-up endoscopy.

• RNY may be safe in patients with NDBE.

• The number of patients identified from all studies is low.

Electronic supplementary material

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Supplementary file1 (DOCX 31 KB)

Appendix

Appendix

Search Strategy and Terms for Each Search Engine

Ovid MEDLINE(R) and In-Process & Other Non-Indexed Citations and Daily (1946 to present)

Search run July 2020

1. Barrett Esophagus/

2. (Barrett$ adj1 (esophagus or oesophagus)).ti,ab.

3. (barrett esophag$ or barrett’s esophag$ or barretts esophag$ or barrett oesophag$ or barrett’s oesophag$ or barretts oesophag$).ti,ab.

4. (esophag$ or oesophag$ or esophagoscop$ or oesophagoscop$).ti,ab.

5. ((esophagogastric or oesophagogastric or gastro-esophageal or gastroesophageal or gastro-oesophageal or gastrooesophageal or esophageal or esophagus or oesophag$) and (inflamed or inflammation or inflammatory or irritat$ or erythem$ or erythaem$ or inflitrat$ or ulcer or ulcers or ulcerat$ or dyspla$ or hyperplas$ or metaplas$)).ti,ab.

6. (reflux or heartburn or GER or GERD or dyspepsi$).ti,ab.

7. exp esophagitis/

8. 1 or 2 or 3 or 4 or 5 or 6 or 7

9. exp Bariatric Surgery/ or exp Obesity/su

10. (jejunoileal bypass$ or vertical banded gastroplast$ or gastric bypass$ or stomach bypass$ or Roux-En-Y or “fobi” or biliopancreatic diversion or gastric band$ or AGB or biliopancreatic diversion$ or gastroplasty or gastroplasties or gastric stapl$ or stomach stapl$ or bariatric$ or “lap. band” or lap-band or “lap band” or gastric partition$ or sleeve gastrectom$).ti,ab.

11. 9 or 10

12. (“weight loss” or “weight reduction” or obesity or bariatric).ti,ab.

13. exp bariatric medicine/

14. 12 or 13

15. (surgery or surgeries or surgical or operation or operations or operative).ti.

16. 14 and 15

17. 11 or 16

18. (prevalence or incidence or epidemiol* or survey or “rapid assessment” or “situation assessment” or “situational assessment” or RAR or cohort or surveillance or seroprevalence or seroincidence or seroepidemiol* or screening).ti,ab,kw. or exp epidemiologic methods/ or exp epidemiologic studies/ or exp sentinel surveillance/ or exp seroepidemiologic studies/ or exp cohort studies/ or exp cross-sectional studies/ or exp longitudinal studies/ or exp follow-up studies/ or exp prospective studies/

19. 8 and 17 and 18

Embase (Elsevier) (1947 – present)

Search run July 2020.

1.‘Barrett esophagus’/exp OR ((Barrett* NEAR/1 esophagus) OR (Barrett* NEAR/1 oesophagus) OR “barrett esophag*” OR “barrett?s esophag*” OR “barretts esophag*” OR “barrett oesophag*” OR “barrett?s oesophag*” OR “barretts oesophag*”):ti,ab OR ((esophagi* OR oesophag* OR esophagoscop* OR oesophagoscop*)):ti,ab OR ((esophagogastric OR oesophagogastric OR gastro-esophageal OR gastroesophageal OR gastro-oesophageal OR gastrooesophageal OR esophageal OR esophagus OR oesophag*) AND (inflamed OR inflammation OR inflammatory OR irritat* OR erythem* OR erythaem* OR inflitrat* OR ulcer OR ulcers OR ulcerat* OR dyspla* OR hyperplas* OR metaplas*)):ti,ab OR (reflux OR heartburn OR GER OR GERD OR dyspepsi*):ti,ab OR ‘esophagitis’/exp.

2.‘Bariatric Surgery’/exp OR ‘Obesity’/exp su OR (“jejunoileal bypass*” OR “vertical banded gastroplast*” OR “gastric bypass*” OR “stomach bypass*” OR Roux-En-Y OR fobi OR “biliopancreatic diversion” OR “gastric band*” OR AGB OR “biliopancreatic diversion*” OR gastroplasty OR gastroplasties OR “gastric stapl*” OR “stomach stapl*” OR bariatric* OR “lap. band” OR lap-band OR “lap band” OR “gastric partition*” OR “sleeve gastrectom*”):ti,ab OR ((‘bariatrics’/exp OR (“weight loss” OR “weight reduction” OR obesity OR bariatric):ti,ab) AND (surgery OR surgeries OR surgical OR operation OR operations OR operative):ti).

3.((prevalence or incidence or epidemiology or survey or surveillance or screening or seroprevalence or seroincidence or cohort or “rapid assessment” or “situation assessment” or “situational assessment” or “RAR”):ti,ab,kw or ‘seroepidemiology’/exp or ‘seroprevalence’/exp or ‘epidemiology’/exp or ‘prevalence’/exp or ‘epidemiological data’/exp or ‘incidence’/exp or ‘observational study’/exp or ‘cohort analysis’/exp).

4. #1 AND #2 AND #3

Web of Science

Science Citation Index Expanded (SCI-EXPANDED) –1900-present

Conference Proceedings Citation Index- Science (CPCI-S) –1993-present

Search run July 2020

TS = (“Barrett Esophagus” OR (Barrett* NEAR/1 esophagus) OR (Barrett* NEAR/1 oesophagus) OR “barrett esophagi*” OR “barrett's esophag*” OR “barretts esophagi” OR “barrett oesophag*” OR “barrett’s oesophag*” OR “barretts oesophag*” OR esophag* OR oesophag* OR esophagoscop* OR oesophagoscop* OR ((esophagogastric OR oesophagogastric OR gastro-esophageal OR gastroesophageal OR gastro-oesophageal OR gastrooesophageal OR esophageal OR esophagus OR oesophag*) AND (inflamed OR inflammation OR inflammatory OR irritat* OR erythem* OR erythaem* OR inflitrat* OR ulcer OR ulcers OR ulcerat* OR dyspla* OR hyperplas* OR metaplas*)) OR reflux OR heartburn OR GER OR GERD OR dyspepsi*).

TS = (“Bariatric Surgery” OR (Obesity NEAR/3 surgery) OR (Obese NEAR/3 surgery) OR “jejunoileal bypass*” OR “vertical banded gastroplast*” OR “gastric bypass*” OR “stomach bypass*” OR Roux-En-Y OR fobi OR “biliopancreatic diversion” OR “gastric band*” OR AGB OR “biliopancreatic diversion*” OR gastroplasty OR gastroplasties OR “gastric stapl*” OR “stomach stapl*” OR bariatric* OR “lap. band” OR lap-band OR “lap band” OR “gastric partition*” OR “sleeve gastrectom*” OR ((“weight loss” OR “weight reduction” OR obesity OR bariatric OR “bariatric medicine”) AND (surgery OR surgeries OR surgical OR operation OR operations OR operative)))

TS = (prevalence OR incidence OR epidemiol* OR survey OR “rapid assessment” OR “situation assessment” OR “situational assessment” OR RAR OR cohort OR surveillance OR seroprevalence OR seroincidence OR seroepidemiol* OR screening OR “epidemiologic methods” OR “epidemiologic studies” OR “sentinel surveillance” OR “seroepidemiologic studies” OR “cohort studies” OR “cross-sectional studies” OR “longitudinal studies” OR “follow-up studies” OR “prospective studies”)

#1 AND #2 AND #3

Cochrane Library and Central Register of Controlled Trials (CENTRAL)

Search run on July 2020

#1[mh ^”Barrett Esophagus”]

#2((Barrett* NEAR1 esophagus) OR (Barrett* NEAR1 oesophagus)):ti,ab

#3(barrett esophag* OR barrett's esophag* OR barretts esophag* OR barrett oesophag* OR barrett’s oesophag* OR barretts oesophag*):ti,ab

#4(esophag* OR oesophag* OR esophagoscop* OR oesophagoscop*):ti,ab

#5((esophagogastric OR oesophagogastric OR gastro-esophageal OR gastroesophageal OR gastro-oesophageal OR gastrooesophageal OR esophageal OR esophagus OR oesophag*) AND (inflamed OR inflammation OR inflammatory OR irritat* OR erythem* OR erythaem* OR inflitrat* OR ulcer OR ulcers OR ulcerat* OR dyspla* OR hyperplas* OR metaplas*)):ti,ab

#6(“reflux” OR “heartburn” OR “GER” OR “GERD” OR “dyspepsi*”):ti,ab

#7[mh esophagitis]

#8 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7

#9[mh “Bariatric Surgery”] OR [mh Obesity] su

#10(“jejunoileal bypass*” OR “vertical banded gastroplast*” OR “gastric bypass*” OR “stomach bypass*” OR “Roux-En-Y OR fobi” OR “biliopancreatic diversion” OR “gastric band*” OR “AGB” OR “biliopancreatic diversion*” OR “gastroplasty” OR “gastroplasties” OR “gastric stapl*” OR “stomach stapl*” OR “bariatric*” OR “lap. band” OR “lap-band” OR “lap band” OR “gastric partition*” OR “sleeve gastrectom*”):ti,ab

#11 #9 OR #10

#12(“weight loss” OR “weight reduction” OR “obesity” OR “bariatric”):ti,ab.

#13[mh “bariatric medicine”]

#14 #12 OR #13

#15(surgery OR surgeries OR surgical OR operation OR operations OR operative):ti

#16 #14 AND #15

#17 #11 OR #16

#18(prevalence OR incidence OR epidemiol* OR survey OR “rapid assessment” OR “situation assessment” OR “situational assessment” OR RAR OR cohort OR surveillance OR seroprevalence OR seroincidence OR seroepidemiol* OR screening):ti,ab,kw OR [mh “epidemiologic methods”] OR [mh “epidemiologic studies”] OR [mh “sentinel surveillance”] OR [mh “seroepidemiologic studies”] OR [mh “cohort studies”] OR [mh “cross-sectional studies”] OR [mh “longitudinal studies”] OR [mh “follow-up studies”] OR [mh “prospective studies”]

#19 #8 AND #17 AND #18

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Qumseya, B., Qumsiyeh, Y., Sarheed, A. et al. Barrett’s Esophagus in Obese Patient Post-Roux-en-Y Gastric Bypass: a Systematic Review. OBES SURG 32, 3513–3522 (2022). https://doi.org/10.1007/s11695-022-06272-w

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