Comment on: Prospective clinical cohort study: Low incidence of Barrett esophagus but high rate of reflux disease at 5-year follow-up after Sleeve Gastrectomy vs. Roux-Y-Gastric Bypass

      The increased incidence of de novo gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) along with its consequences, including the potential transformation into Barrett’s esophagus (BE) and ultimately esophageal cancer, impelled an increased number of publications on this subject. In an attempt to better understand the true incidence of BE after two commonly performed bariatric procedures, laparoscopic SG and laparoscopic Roux-en-Y gastric bypass (RYGB), Wo¨lnerhanssen et al. prospectively studied a cohort of 169 patients (86 RYGB and 83 SG) to evaluate the postoperative development of BE after at least 5 years of follow-up. After a median of 7.0±1.5 years, the incidence of BE in SG and RYGB group were 3.6% vs. 1.2% respectively (p=0.362), concluding that there was no statistically significant increased risk of BE after SG compared to RYGB. On the other hand, patients in the SG group did have higher rates of dyspeptic symptoms, reflux esophagitis, pathological acid exposure and use of proton pump inhibitors when compared to RYGB. Of note, 22 patients were converted from sleeve to bypass and were excluded from the analysis and this could have skewed the reported outcomes.
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