P1816 - Gastroesophageal Reflux Disease, Esophagitis, and Barrett’s Esophagus Post Sleeve Gastrectomy: A Systematic Review and Meta-Analysis

Rami Musallam, MD¹, Syed Hamaad Rahman, DO², Faris Shweikeh, MD³, Alexis Bennett, MD⁴, Azizullah Beran, MD⁵, Rania Daaboul, MS⁶, Wasef Sayeh, MD⁷, Babu Mohan, MD, MS⁸, Mohannad Abousaleh, MD⁹, C. Roberto Simons-Linares, MD¹⁰, Emad Mansoor, MD¹¹, Gregory Cooper, MD¹², Ahmed Shamia, MD^10
1Case Western Reserve University School of Medicine, Cleveland, OH; ²Methodist Dallas Medical Center, Dallas, TX; ³Cleveland Clinic Akron General, Akron, OH; ⁴Case Western Reserve University/Cleveland Medical Center, Cleveland, OH; ⁵Indiana University, Indianapolis, IN; ⁶Oakland University William Beaumont School of Medicine, Farmington Hills, MI; ⁷University of Toledo, Toledo, OH; ⁸University of Utah Health School of Medicine, Salt Lake City, UT; ⁹Huron Gastroenterology, Ann Arbor, MI; ¹⁰Cleveland Clinic, Cleveland, OH; ¹¹Case Western Reserve University / University Hospitals, Cleveland, OH; ¹²Case Western Reserve/UHCMC, Cleveland, OH

Introduction: Sleeve gastrectomy (SG) has become increasingly popular in bariatric surgery. However, SG is associated with gastroesophageal reflux (GERD) and esophagitis, with concerns for progression into Barrett’s esophagus (BE). We aimed to assess the prevalence of BE in patients who had undergone SG.

Methods: We performed a comprehensive search in the databases of PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception through June 2023. Meta-analysis was performed by standard methodology using the random-effects model and heterogeneity was assessed using the I2% statistics. We included studies on patients who had undergone esophagogastroduodenoscopy (EGD) after SG. The primary outcome was the prevalence of BE in patients who had undergone SG. Secondary outcomes include prevalence of GERD, esophagitis and proton pump inhibitors (PPI) use following SG.

Results: Our final analysis included 24 studies (9 prospective, 15 retrospectives) that included 2583 patients who had undergone EGD 6 months to 15 years after SG. The pooled prevalence of BE was 7.4% [(95% confidence interval (CI), 4.9-10.9%; I2 = 79.7%]. Of these, 12.3% [95% CI: 7.8-19, I2 = 29.9%] were associated with GERD. No dysplasia was reported. We found an increase of postoperative GERD after SG with a rate of 53.2% [95% CI: 44.5-61.7, I2 = 91.7%] compared with preoperative rate of 24.9% [95% CI: 19.5-31.1, I2 = 82.8%] and the rate of postoperative esophagitis was 40.2% [95% CI: 32.7-48.1, I2 = 91.9%] compared with preoperative rate of 13.9% [95% CI: 10.3-18.4, I2 = 82.8%]. Moreover, the rate of postoperative PPI use was 42.1% [95% CI: 28.3-57.3, I2 = 94.2%] compared with preoperative rate of 20.5% [95% CI: 16.4-25.2, I2 = 50.7%]. Three percent of all patients required conversion to RYGB for severe reflux.

Discussion: This study shows a high prevalence of Barrett’s esophagus up to 15 years post-SG. Furthermore, the postoperative prevalence of esophagitis, GERD and PPI use almost doubled post-SG. Screening for BE should be considered in all patients after SG.


Disclosures:


Rami Musallam, MD¹, Syed Hamaad Rahman, DO², Faris Shweikeh, MD³, Alexis Bennett, MD⁴, Azizullah Beran, MD⁵, Rania Daaboul, MS⁶, Wasef Sayeh, MD⁷, Babu Mohan, MD, MS⁸, Mohannad Abousaleh, MD⁹, C. Roberto Simons-Linares, MD¹⁰, Emad Mansoor, MD¹¹, Gregory Cooper, MD¹², Ahmed Shamia, MD¹⁰. P1816 - Gastroesophageal Reflux Disease, Esophagitis, and Barrett’s Esophagus Post Sleeve Gastrectomy: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.