A 65-year-old male patient, underwent Vertical Gastrectomy in 2017 for the treatment of Morbid Obesity. Lost follow-up during the COVID-19 pandemic, having only done a follow-up endoscopy in the first postoperative year.
Returns to the clinic with significant symptoms of heartburn and daily regurgitation, impacting quality of life and food tolerance. EDA requested, with the finding of a projection of columnar mucosa, salmon-pink in color in the distal third of the esophagus, measuring about 10 mm circumferentially. Biopsies were performed with confirmation of intestinal columnar metaplasia, compatible with the diagnosis of Barrett’s Esophagus.
Although uncommon in our environment, the diagnosis of Barrett’s Esophagus after VG has been increasingly reported in the literature. A recent meta-analysis showed a prevalence of 11.4%, with a grouped Barrett rate in patients with GERD symptoms of 18.2% (95% CI, 12.4% – 26%). Such a study also showed that there was no significant difference in the likelihood of having Barrett based on GERD symptoms.
Therefore, to make an early diagnosis of Barrett after Vertical Gastrectomy and maintain adequate clinical and endoscopic follow-up, we should follow the IFSO recommendation to perform upper digestive endoscopy annually in patients undergoing sleeve regardless of symptoms.
References
- Qumseya BJ, Qumsiyeh Y, Ponniah SA, Estores D, Yang D, Johnson-Mann CN, Friedman J, Ayzengart A, Draganov PV. Barrett’s esophagus after sleeve gastrectomy: a systematic review and meta-analysis. Gastrointest Endosc. 2021 Feb;93(2):343-352.e2. doi: 10.1016/j.gie.2020.08.008. Epub 2020 Aug 14. PMID: 32798535.
- Brown WA, Johari Halim Shah Y, Balalis G, Bashir A, Ramos A, Kow L, Herrera M, Shikora S, Campos GM, Himpens J, Higa K. IFSO Position Statement on the Role of Esophago-Gastro-Duodenal Endoscopy Prior to and after Bariatric and Metabolic Surgery Procedures. Obes Surg. 2020 Aug;30(8):3135-3153. doi: 10.1007/s11695-020-04720-z. PMID: 32472360.
How to cite this article
Dantas ACB, Vertical Gastrectomy and risk of Barrett’s Esophagus. Gastropedia; 2022. Available at: https://gastropedia.com.br/cirurgia/obesidade/gastrectomia-vertical-e-risco-de-esofago-de-barrett/
Cirurgiã do Aparelho Digestivo pelo HC-FMUSP – RQE 95665
Certificada em área de atuação em Cirurgia Bariátrica – RQE 956641
Membro Titular CBC, CBCD e SCBCM
