Original article|Articles in Press

Reflux and Barrett’s esophagus after sleeve gastrectomy: analysis of a statewide database

Published:February 14, 2023DOI:


      • In this analysis, only 35% of patients who underwent sleeve gastrectomy ever had an endoscopy, with the vast majority of endoscopies being performed in the first year before surgery.
      • There were high pre-operative diagnostic rates for gastro-esophageal reflux disease (54.9%), and esophagitis (14.6%) in this cohort.
      • Gastro-esophageal reflux disease symptoms decreased after surgery. However, in patients who had endoscopy, there was a high incidence of new diagnoses for reflux esophagitis (85% at 5 years) and Barrett’s esophagus (6.4% at 5 years).
      • Rates of post-operative reflux and Barrett’s esophagus are higher than expected given the pre-operative rates. It may be reasonable to increase endoscopic screening both pre- and post- operatively.



      Recent studies have suggested that sleeve gastrectomy (SG) is associated with the development of Barrett esophagus (BE) even in the absence of gastroesophageal reflux disease (GERD) symptoms.


      The aim of this study was to assess the rates of upper endoscopy and incidence of new BE diagnoses in patients undergoing SG.


      This was a claims-data study of patients who underwent SG between 2012 and 2017 while enrolled in a U.S. statewide database.


      Diagnostic claims data were used to identify pre- and postoperative rates of upper endoscopy, GERD, reflux esophagitis, and BE. Time-to-event analysis using a Kaplan-Meier approach was performed to estimate the cumulative postoperative incidence of these conditions.


      We identified 5562 patients who underwent SG between 2012 and 2017. Of these, 1972 patients (35.5%) had at least 1 diagnostic record of upper endoscopy. The preoperative incidences of a diagnosis of GERD, esophagitis, and BE were 54.9%, 14.6%, and .9%, respectively. The predicted postoperative incidences of GERD, esophagitis, and BE, respectively, were 18%, 25.4%, and 1.6% at 2 years and 32.1%, 85.0%, and 6.4% at 5 years.


      In this large statewide database, rates of esophagogastroduodenoscopy remained low after SG, but the incidence of a new postoperative esophagitis or BE diagnosis in patients who underwent esophagogastroduodenoscopy was higher than in the general population. Patients undergoing SG may have a disproportionately high risk of developing reflux complications including BE after surgery.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Genco A.
        • Soricelli E.
        • Casella G.
        • et al.
        Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication.
        Surg Obes Relat Dis. 2017; 13: 568-574
        • Hayeck T.J.
        • Kong C.Y.
        • Spechler S.J.
        • Gazelle G.S.
        • Hur C.
        The prevalence of Barrett’s esophagus in the US: estimates from a simulation model confirmed by SEER data.
        Dis Esophagus. 2010; 23: 451-457
        • Felsenreich D.M.
        • Kefurt R.
        • Schermann M.
        • et al.
        Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up.
        Obes Surg. 2017; 27: 3092-3101
        • Sebastianelli L.
        • Benois M.
        • Vanbiervliet G.
        • et al.
        Systematic endoscopy 5 years after sleeve gastrectomy results in a high rate of Barrett’s esophagus: results of a multicenter study.
        Obes Surg. 2019; 29: 1462-1469
        • Qumseya B.J.
        • Qumsiyeh Y.
        • Ponniah S.A.
        • et al.
        Barrett’s esophagus after sleeve gastrectomy: a systematic review and meta-analysis.
        Gastrointest Endosc. 2021; 93: 343-352.e2
      1. American Society for Metabolic and Bariatric Surgery [Internet]. Newberry (FL): The Society; 2022 [cited 2022 May 1]. Estimates of bariatric surgery numbers, 2011–2018; [about 2 screens]. Available from:

        • Parikh M.
        • Liu J.
        • Vieira D.
        • et al.
        Preoperative endoscopy prior to bariatric surgery: a systematic review and meta-analysis of the literature.
        Obes Surg. 2016; 26: 2961-2966
        • Bennett S.
        • Gostimir M.
        • Shorr R.
        • Mallick R.
        • Mamazza J.
        • Neville A.
        The role of routine preoperative upper endoscopy in bariatric surgery: a systematic review and meta-analysis.
        Surg Obes Relat Dis. 2016; 12: 1116-1125
        • DuPree C.E.
        • Blair K.
        • Steele S.R.
        • Martin M.J.
        Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis.
        JAMA Surg. 2014; 149: 328-334
        • Navarini D.
        • Madalosso C.A.S.
        • Tognon A.P.
        • Fornari F.
        • Barão F.R.
        • Gurski R.R.
        Predictive factors of gastroesophageal reflux disease in bariatric surgery: a controlled trial comparing sleeve gastrectomy with gastric bypass.
        Obes Surg. 2020; 30: 1360-1367
        • Greilsamer T.
        • de Montrichard M.
        • Bruley des Varannes S.
        • et al.
        Hypotonic low esophageal sphincter is not predictive of gastroesophageal reflux disease after sleeve gastrectomy.
        Obes Surg. 2020; 30: 1468-1472
        • Ali M.
        • El Chaar M.
        • Ghiassi S.
        • Rogers A.M.
        American Society for Metabolic and Bariatric Surgery updated position statement on sleeve gastrectomy as a bariatric procedure.
        Surg Obes Relat Dis. 2017; 13: 1652-1657
        • Oor J.E.
        • Roks D.J.
        • Ünlü Ç.
        • Hazebroek E.J.
        Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis.
        Am J Surg. 2016; 211: 250-267
        • Stenard F.
        • Iannelli A.
        Laparoscopic sleeve gastrectomy and gastroesophageal reflux.
        World J Gastroenterol. 2015; 21: 10348-10357
        • Campos G.M.
        • Mazzini G.S.
        • Altieri M.S.
        • Docimo Jr., S.
        • DeMaria E.J.
        • Rogers A.M.
        ASMBS position statement on the rationale for performance of upper gastrointestinal endoscopy before and after metabolic and bariatric surgery.
        Surg Obes Relat Dis. 2021; 17: 837-847
        • Braghetto I.
        • Csendes A.
        Prevalence of Barrett’s esophagus in bariatric patients undergoing sleeve gastrectomy.
        Obes Surg. 2016; 26: 710-714
        • Qumseya B.J.
        • Bukannan A.
        • Gendy S.
        • et al.
        Systematic review and meta-analysis of prevalence and risk factors for Barrett’s esophagus.
        Gastrointest Endosc. 2019; 90: 707-717.e1
        • Andrici J.
        • Cox M.R.
        • Eslick G.D.
        Cigarette smoking and the risk of Barrett’s esophagus: a systematic review and meta-analysis.
        J Gastroenterol Hepatol. 2013; 28: 1258-1273
        • Rawlins L.
        • Rawlins M.P.
        • Brown C.C.
        • Schumacher D.L.
        Sleeve gastrectomy: 5-year outcomes of a single institution.
        Surg Obes Relat Dis. 2013; 9: 21-25
        • Soricelli E.
        • Iossa A.
        • Casella G.
        • Abbatini F.
        • Calì B.
        • Basso N.
        Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia.
        Surg Obes Relat Dis. 2013; 9: 356-361
        • Braghetto I.
        • Csendes A.
        • Korn O.
        • Valladares H.
        • Gonzalez P.
        • Henríquez A.
        Gastroesophageal reflux disease after sleeve gastrectomy.
        Surg Laparosc Endosc Percutan Tech. 2010; 20: 148-153
        • Altieri M.S.
        • Pryor A.D.
        Gastroesophageal reflux disease after bariatric procedures.
        Surg Clin North Am. 2015; 95: 579-591
        • Chen W.
        • Feng J.
        • Wang C.
        • Wang Y.
        • Yang W.
        • Dong Z.
        Effect of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastroesophageal reflux disease in patients with obesity: a systematic review and meta-analysis.
        Obes Surg. 2021; 31: 3905-3918
        • Ronkainen J.
        • Aro P.
        • Storskrubb T.
        • et al.
        Prevalence of Barrett’s esophagus in the general population: an endoscopic study.
        Gastroenterology. 2005; 129: 1825-1831
        • Runge T.M.
        • Abrams J.A.
        • Shaheen N.J.
        Epidemiology of Barrett’s esophagus and esophageal adenocarcinoma.
        Gastroenterol Clin North Am. 2015; 44: 203-231
        • Hvid-Jensen F.
        • Pedersen L.
        • Drewes A.M.
        • Sørensen H.T.
        • Funch-Jensen P.
        Incidence of adenocarcinoma among patients with Barrett’s esophagus.
        N Engl J Med. 2011; 365: 1375-1383
        • Wani S.
        • Falk G.
        • Hall M.
        • et al.
        Patients with nondysplastic Barrett’s esophagus have low risks for developing dysplasia or esophageal adenocarcinoma.
        Clin Gastroenterol Hepatol. 2011; 9: 220-227.e1
        • Andalib A.
        • Bouchard P.
        • Demyttenaere S.
        • Ferri L.E.
        • Court O.
        Esophageal cancer after sleeve gastrectomy: a population-based comparative cohort study.
        Surg Obes Relat Dis. 2021; 17: 879-887