S1056 The Prevalence of Barrett’s Esophagus and Esophageal Adenocarcinoma After Laparoscopic Sleeve Gastrectomy

Introduction: Laparoscopic sleeve gastrectomy (LSG) has become the most popular bariatric procedure performed worldwide. With the rise in patients undergoing LSG, gastroesophageal reflux disease (GERD) has emerged as a concerning side effect of this operation. Chronic GERD is a well-established risk factor for the development of Barrett’s esophagus (BE), a pre-malignant condition for esophageal adenocarcinoma (EAC). There have been few studies investigating the risk of BE after LSG. The aim of this study was to determine the prevalence of BE and EAC in patients who have undergone LSG. Methods: We conducted a retrospective, observational study of patients who underwent LSG at 4 hospitals within a regional health network from 2014 to 2023. Patients included were those who had an esophagogastroduodenoscopy (EGD) with biopsy prior to and at least 6 months after LSG. International Classification of Diseases 9/10 PCS codes were used to identify patients with LSG and Current Procedural Terminology code for EGD with biopsy. EGD and pathology reports were reviewed to confirm the diagnosis of BE and/or EAC. Clinical risk factors were evaluated in patients with and without BE. Statistical analyses were performed in R version 4.4.2. Results: Of the 422 LSG patients who had an EGD with biopsy after surgery, 5 patients (1.2%) were found to have BE that was not found on the pre-operative (pre-op) EGD, and there were no patients with EAC. Gender, race, tobacco use, GERD, hiatal hernia, proton pump inhibitor use, esophagitis and Helicobacter pylori did not significantly differ between the 2 groups. Patients with BE were significantly older than patients without BE at the time of the pre-operative and post-operative EGD (55 vs 43; P = 0.002, 59 vs 47; P = 0.004). The BE group had a lower mean body mass index (BMI) and higher percentage of total body weight loss (TBWL) at post-operative EGD than the cohort without BE (29 vs 38; P = 0.016, 37 vs 20; P = 0.039). There was an association between older age and greater TBWL at post-operative EGD with BE (odds ratio [OR] 1.18; P = 0.006, OR 1.08; P = 0.003). Patients with a higher BMI post-operative had a lower odds of BE (OR 0.84; P = 0.029). Conclusion: The prevalence of BE among patients with LSG was found to be no greater than rates observed in the general population, approximately 1-2%. Therefore, having a history of LSG may not be sufficient to recommend screening for BE after surgery. Future longitudinal studies evaluating disease risk in this patient population over multiple decades are needed for further confirmation of these results.