Treatment of Barrett's esophagus following sleeve gastrectomy by conversion to Roux-en-Y gastric bypass: a systematic review and pooled proportions analysis.

[INTRODUCTION] Barrett's esophagus (BE) is a metaplastic, premalignant condition that can develop following sleeve gastrectomy (SG). While various treatment modalities exist for management of post-SG BE, conversion to Roux-en-Y gastric bypass (RYGB) can be an effective option which can also improve gastroesophageal reflux disease (GERD). However, the effectiveness of RYGB for resolving BE has not been rigorously studied. This systematic review evaluates the outcomes of BE in patients converted from SG to RYGB.

[METHODS] A comprehensive literature search was conducted in Ovid MEDLINE, Ovid Embase, PubMed, and Cochrane Library. Studies reporting BE onset following SG and subsequent RYGB conversion were included. Data extracted included patient demographics, Prague classification, dysplasia status, time from SG to BE diagnosis and time to RYGB conversion, and resolution of BE post-RYGB. The validated MINORS tool was used to assess the quality and risk of bias of reviewed studies.

[RESULTS] A total of 4 studies were included, comprising 21 patients who underwent conversion from SG to RYGB with BE. The weighted mean age at RYGB was 46.7 ± 13.8 years, with an initial BMI of 44.7 ± 2.7 kg/m and post-SG BMI of 32.5 ± 6.9 kg/m. The time for conversion between SG and RYGB occurred at an average of 58 ± 19.31 months. BE resolution was observed in 81% of patients, while dysplasia resolved in n = 1/1 patients. No significant perioperative complications were noted.

[CONCLUSION] Based on these results, SG to RYGB conversion appears to be an effective intervention for BE, with the majority of patients achieving histological regression and resolution of symptoms. While preliminary findings indicate favorable outcomes, further studies with bigger sample sizes, longer follow-ups and more diverse patient pools are needed.