Barrett's Esophagus in Obese Patient Post-Roux-en-Y Gastric Bypass: a Systematic Review

Purpose Barrett's esophagus (BE) is a relative contraindication for sleeve gastrectomy, but not for Roux-en-Y gastric bypass (RNY). However, studies assessing the effect of RNY on BE are limited. We aimed to conduct a systematic review and meta-analysis of studies of obese patients who also had BE and underwent RNY. Materials and Methods We conducted a systematic review of literature using multiple search engines from inception to January 2021. The primary outcome of interest was the rate of BE resolution post-RNY. This was reported as a proportion with 95% confidence intervals (CI). Publication bias was assessed by funnels plots and the classic fail test. Forest plots were used to report pooled effect estimates. Heterogeneity was assessed using I-2 and p-value. Results The final search included 4389 citations, 16 were reviewed in full text, and 9 were included in the final analysis, including 7 manuscripts and 2 recent meeting abstracts. In the 9 studies, 104 patients had BE and underwent RNY. On random effect modeling, the rate of complete remission of intestinal metaplasia (CRIM) was 50% [95%CI: 40-61%], p= 0.937, I-2 = 4.6 % , Q= 8.4, p = 0.396. The pooled rate of BE improvement was 52% [95%CI: 37-66%], p = 0.8, I-2 = 16.5%, Q=4.8, p = 0.31. Complete remission of dysplasia (CRD) was also reported in 4 of 6 patients. Conclusion Despite the limited data, a majority of patient with BE who underwent RNY for weight loss had remission or improvement in BE on follow-up endoscopy. However, a significant minority had no change to BE on follow-up.