S854 Increased Risk of Barrett’s Esophagus After Bariatric Surgery: A Propensity-Matched Analysis of 57,035 Patients

Introduction: Bariatric surgeries are widely utilized for obesity management, however, their impact on the risk of developing Barrett’s esophagus (BE) remains uncertain. The aim of this study was to evaluate the long-term risk of BE after bariatric surgery using a large real-world cohort. Methods: A retrospective cohort study was conducted using the TriNetX database (2000-2020). Adult patients >18 years with body mass index ≥30 kg/m² who underwent bariatric procedures (sleeve gastrostomy and gastric bypass) were identified using Current Procedural Terminology codes. Obese adults who did not undergo bariatric surgeries and presented to the clinic were identified as a control group. Individuals with pre-existing BE, esophageal adenocarcinoma (EAC), esophagectomy, or other types of gastric surgeries were excluded. Propensity score matching (PSM) (1:1) was conducted, adjusting for demographics and relevant comorbidities. The primary outcome was the risk of BE, while secondary outcomes were the development of EAC, gastroesophageal reflux disease (GERD), esophagitis, and new proton pump inhibitor use. Risk ratios (RR) with 95% confidence intervals (CI) were calculated for each outcome. Results: A total of 58,910 patients underwent bariatric surgeries (31,228 sleeve; 27,682 gastric bypass), while 1,049,231 patients were in the control group before PSM. After matching, a total of 57,035 patients remained in each group. Bariatric surgery was associated with a higher incidence of Barrett’s esophagus compared to the control group (0.8% vs 0.5%; RR 1.39; 95% CI 1.207 - 1.618; P < 0.001). Nondysplastic BE was significantly higher in the bariatric surgeries group (0.8% vs 0.4%; RR 1.77; 95% CI 1.38-2.27; P < 0.001), however, no significant increases were noted in dysplastic BE (0.07% vs 0.05%; RR 1.60; 95% CI 0.73-3.53), esophageal adenocarcinoma (0.05% vs 0.026%; RR 1.73; 99% CI 0.92-3.37), and esophagitis (RR 0.78; 95% CI 0.69-1.12; P < 0.5). Compared to obese controls, bariatric surgery patients had lower risk of reflux-mediated outcomes: GERD (24.04% vs 26.61%; RR 0.91; 95% CI 0.84-0.93; P < 0.001), and need for PPI use (35.2% vs 42.0%; RR 0.84; 95% CI 0.81-0.87; P < 0.001). Conclusion: In this large real-world cohort study, the risk of Barrett’s esophagus was higher in patients who underwent bariatric surgeries; however, bariatric surgeries were associated with substantial reductions in the development of GERD and PPI utilization. Prospective studies and tailored surveillance strategies for post-bariatric patients are warranted.