P3268 - Do Bariatric Procedures Impact Barrett’s Esophagus and Esophageal Cancers? Systematic Review and Meta-Analysis

Ankit Chhoda, MD¹, Maria Hernandez Woodbine, MD¹, Mahmoud H. Abdalla, MD², Sanam Hariri, MD³, Tatiana Andrea Rojas Zapata, MD⁴, Alyssa Grimshaw, MBA⁵, Douglas Pleskow, MD, FACG⁶, Violeta Popov, MD, PhD, FACG⁷, Erik Holzwanger, MD^1
1Beth Israel Deaconess Medical Center, Boston, MA; ²AdventHealth, Tampa, FL; ³Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; ⁴Universidad del Norte, Cali, Valle del Cauca, Colombia; ⁵Yale University Libraries, West Haven, CT; ⁶BIDMC, Boston, MA; ⁷NYU Langone Health, New York, NY

Introduction: Barret’s esophagus (BE), a precursor to esophageal adenocarcinoma (EAC), has high prevalence of 0.5–2.0% & has increasing burden in the Western World. Although BE & EAC are associated with chronic reflux, their burden among bariatric population procedures is compelling domain for investigation. Among patients undergoing bariatric surgeries, we aimed to quantify the incidence & progression of BE & the overall risk of esophageal carcinogenesis.

Methods: A systematic search from Cochrane, Embase, Google Scholar, Medline, PubMed, Scopus, & Web of Science identified bariatric surgical studies with discrete endoscopic & histological findings. The outcomes of interest included: patient demographics, type of bariatric procedure (classified as Group I: Roux-en-Y Gastric Bypass; II: Sleeve Gastrectomy; III: Biliopancreatic Diversion with Duodenal Switch; IV: Adjustable Gastric Banding), pre- & post-bariatric procedural endoscopic and histological findings. The burden of BE, EAC, BE progression was described as pooled incidence[95% confidence intervals] & meta-analysis was performed using a random-effects model.

Results: 40 underwent systematic review & 35 studies were meta-analyzed. 119,908 eligible patients underwent bariatric surgeries & were included (Group I(n= 75,050), II(n= 14,704), III(n= 445), & IV(n= 29,709). Among 59,572 patients with normal baseline, the pooled incidence of BE after bariatric procedures was 1.1% (0.3%-1.9%; I2=0.0%) (Fig.1A). The BE incidence was higher among Group II:1.4%(0.3%-1.9%; I2=0.1%) vs. Group I:1.0%(0.3%-2.1%; I2=0.1%) , albeit statistically insignificant. The incidence of advanced neoplasia, i.e BE with high-grade dysplasia or EAC among the overall population was 0.2%(0.0%-1.0%; I2=0.0) whereas among screen-prevalent BE was 5.5%[0-16.2%; I2=0.0] (Fig.1B). No publication bias was observed among studies describing BE incidence (P=0.13) & progression (P=0.6) (Fig.1C).

Discussion: EAC has a projected 5-year survival of only 21.7% thus the aforementioned risk of esophageal carcinogenesis among pre-existing BE is not trivial & may warrant eradication therapy. Due to sparse controlled studies, the actual carcinogenesis risk from bariatric surgeries remains elusive. Currently, it is still unknown if the risk of bariatric endoscopic procedures carries the same risk of progression of BE as compared to their surgical counterparts. Future high-quality prospective studies are needed to guide in management of high-risk patients undergoing bariatric interventions.





Disclosures:


Ankit Chhoda, MD¹, Maria Hernandez Woodbine, MD¹, Mahmoud H. Abdalla, MD², Sanam Hariri, MD³, Tatiana Andrea Rojas Zapata, MD⁴, Alyssa Grimshaw, MBA⁵, Douglas Pleskow, MD, FACG⁶, Violeta Popov, MD, PhD, FACG⁷, Erik Holzwanger, MD¹. P3268 - Do Bariatric Procedures Impact Barrett’s Esophagus and Esophageal Cancers? Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.