P0421 - Outcomes of Patients With Eosinophilic Esophagitis Undergoing Bariatric Surgery

Nimrod Deiss-Yehiely, MD, Luke Hillman, MD
University of Wisconsin, Madison, WI

Introduction: Bariatric surgery is a weight loss option for those with obesity and an obesity related co-morbid condition such as gastroesophageal reflux disease (GERD). In patients with GERD, Roux-en-Y gastric bypass (RNY) is preferred over sleeve gastrectomy (SG) due to the risk of worsening GERD with SG. Little is known about bariatric surgery and eosinophilic esophagitis (EoE) but anecdotally SG is avoided due to the complex and evolving relationship between EoE and GERD. This study seeks to investigate the outcomes of patients with EoE undergoing bariatric surgery.

Methods: We preformed retrospective chart review of patients with EoE who underwent bariatric surgery with RNY or SG at the University of Wisconsin between 10/1/2015 and 1/18/2023.The primary outcome of the study was to assess disease progression defined as either histologic relapse of disease (≥15 eos/hpf), need to step up therapy due to active disease, or clinically worsening symptoms.

Results: 15 patients with EoE underwent bariatric surgery were identified: 9 RNY and 6 SG. Pre-operatively, 57% of patients in the RNY group and 67% in the SG group had active EoE (≥15 eos/hpf) with 100% and 83% on medical therapy, respectively [Table 1]. At a mean follow-up time of 10 months, only 3 patients underwent post-operative EGD: 2 RNY who were in histologic remission and 1 SG with active disease but was asymptomatic. One patient in the RNY group required stricture dilation post-op while none did in the SG group. No patients in either group required escalation in medical therapy post-operatively with 67% in the RNY and 50% in the SG group able to de-escalate therapy. 22% of patients in the RNY group reported dysphagia post-op, while no patients in the LSG group reported dysphagia. Mean total body weight loss was 21% (sd 10%) in the RNY group and 22% (sd 5%) in the SG group at a mean follow-up time of 6 and 17 months, respectively.

Discussion: Patients with EoE who undergo bariatric surgery have excellent outcomes with a mean TBW of 21% after RNY and 22% after SG. Importantly, there was no clinical worsening of EoE symptoms, particularly dysphagia, or need to escalate therapy in patients undergoing SG. Future studies with greater post-operative histologic data are needed, but our data suggests SG is a safe and effective weight loss option for patients with EoE.


Disclosures:


Nimrod Deiss-Yehiely, MD, Luke Hillman, MD. P0421 - Outcomes of Patients With Eosinophilic Esophagitis Undergoing Bariatric Surgery, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.