Dr. Nicola Basso

High incidence of erosive esophagitis and Barrett’s esophagus after sleeve gastrectomy

Clinical Case The prevalence of Barrett’s esophagus in Europe is around 1.3% to 1.6%. This incidence is claimed to be higher in patients on whom a sleeve gastrectomy has been performed. Dr. Alfredo Genco , from the Department of Surgical Sciences at La Sapienza University in Rome (Italy) argues that evaluating the gastroesophageal reflux after a sleeve on the basis of symptoms only is not enough. He reviews the literature and explains that there is an increase of Barrett’s esophagus from 0% to 14% in the long-term follow-up and that > 70% of the patients have bile reflux when evaluated with gastroscopy. Nearly 80% of patients have esophagitis according to the Los Angeles criteria. All this may be secondary to an intrathoracic migration of the esophago-gastric junction (72% of patients). He concludes that Barrett’s esophagus can progress despite medical therapy, and thus close follow-up including gastroscopy should be mandatory . In order to reduce reflux and its complications, a change of surgical procedure is needed to make sleeve gastrectomy safer. An international panel of experts from IFSO composed by Dr. Genco, Dr. Himpens, Dr. Lakdawala, Dr. Ramos, Dr. Angrisani, Dr. Higa, Dr. Zundel and Dr. Nimeri discuss the importance of GERD after sleeve gastrectomy, the treatment and prevention of Barrett’s esophagus in these patients, and the role of endoscopic follow-up and IBPs in these patients.