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Insights into the Paradox of the Weak Association Between Sleeve Gastrectomy and Barrett’s Esophagus

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Abstract

Sleeve gastrectomy (SG) is deemed a refluxogenic operation but with a low incidence of postoperative Barrett´s esophagus (BE). We aimed to shed some light on the potential paradox of the weak association between SG, BE and esophageal adenocarcinoma (EAC). The high incidence of GERD after SG is not followed by an increased rate of BE and EAC, as these rates are similar to the general population. We hypothesized that this paradox may occur due to a difference in the gastro-esophageal reflux composition secondary to a lower content of bile, to a decrease in inflammation due to weight loss and hormonal changes, and to acquisition of healthier habits such as exercise, smoking cessation, and better eating behavior.

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Authors and Affiliations

  1. Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP, 04037-003, Brazil

    Rafaella Orlow, Fernando A. M. Herbella & Rafael C. Katayama

  2. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    Marco G. Patti

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RO: acquisition of data, data analysis, drafting the article, final approval of the version to be published.

FAMH: Conception and design, acquisition of data, data analysis, drafting the article, final approval of the version to be published.

RCK: Conception and design, final approval of the version to be published.

MGP: Conception and design, review for intellectual content, final approval of the version to be published.

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Correspondence to Fernando A. M. Herbella.

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Keypoints

• Sleeve gastrectomy is deemed a refluxogenic operation but with a low incidence of postoperative Barrett´s esophagus.

• Esophageal adenocarcinoma, another consequence of gastroesophageal reflux disease, is also rare after sleeve gastrectomy.

• This paradox may occur due to a difference in the gastroesophageal reflux composition secondary to a lower content of bile, to a decrease in inflammation due to weight loss and hormonal changes, and to acquisition of healthier habits such as exercise, smoking cessation, and better eating behavior.

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Orlow, R., Herbella, F.A.M., Katayama, R.C. et al. Insights into the Paradox of the Weak Association Between Sleeve Gastrectomy and Barrett’s Esophagus. OBES SURG 33, 1910–1915 (2023). https://doi.org/10.1007/s11695-023-06599-y

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