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Abstract：
BACKGROUND: Bariatric surgery is an effective treatment for obesity and may decrease the morbidity and mortality of obesity-associated cancers.
OBJECTIVE: We investigated the risk of a new diagnosis of Barrett esophagus (BE) following bariatric surgery compared to screening colonoscopy controls.
METHODS: Large national database including patients who received care in inpatient, outpatient, and specialty care services.
METHODS: A national healthcare database (TriNetX, LLC) was used for this analysis. Cases included adults (aged ≥18 yr) who had undergone either sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Controls included adults undergoing screening colonoscopy and an esophagoduodenoscopy on the same day and had never undergone bariatric surgery. Cases and controls were propensity-matched for confounders. The risk of de novo diagnosis of BE at least 1 year after bariatric surgery was compared between cases and controls. Secondary analyses examined the effect of bariatric surgery on metabolic outcomes such as weight loss and body mass index (BMI). The risk of de novo diagnosis of BE in SG was compared with RYGB. Odds ratios (OR) and 95% CI were used to report on these associations.
RESULTS: In the propensity-matched analysis, patients who had undergone a bariatric surgical procedure showed a significantly reduced risk of de novo BE when compared with screening colonoscopy controls (.67 [.48, .94]). There was substantial reduction in weight and BMI in the bariatric surgery group when compared with baseline. There was no significant difference in de novo BE diagnosis between the propensity-matched SG and RYGB groups (.77 [.5, 1.2]).
CONCLUSIONS: Patients who underwent bariatric surgery (RYGB or SG) had a lower risk of being diagnosed with BE compared with screening colonoscopy controls who did not receive bariatric surgery. This effect appears to be largely mediated by reduction in weight and BMI.
OBJECTIVE: We investigated the risk of a new diagnosis of Barrett esophagus (BE) following bariatric surgery compared to screening colonoscopy controls.
METHODS: Large national database including patients who received care in inpatient, outpatient, and specialty care services.
METHODS: A national healthcare database (TriNetX, LLC) was used for this analysis. Cases included adults (aged ≥18 yr) who had undergone either sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Controls included adults undergoing screening colonoscopy and an esophagoduodenoscopy on the same day and had never undergone bariatric surgery. Cases and controls were propensity-matched for confounders. The risk of de novo diagnosis of BE at least 1 year after bariatric surgery was compared between cases and controls. Secondary analyses examined the effect of bariatric surgery on metabolic outcomes such as weight loss and body mass index (BMI). The risk of de novo diagnosis of BE in SG was compared with RYGB. Odds ratios (OR) and 95% CI were used to report on these associations.
RESULTS: In the propensity-matched analysis, patients who had undergone a bariatric surgical procedure showed a significantly reduced risk of de novo BE when compared with screening colonoscopy controls (.67 [.48, .94]). There was substantial reduction in weight and BMI in the bariatric surgery group when compared with baseline. There was no significant difference in de novo BE diagnosis between the propensity-matched SG and RYGB groups (.77 [.5, 1.2]).
CONCLUSIONS: Patients who underwent bariatric surgery (RYGB or SG) had a lower risk of being diagnosed with BE compared with screening colonoscopy controls who did not receive bariatric surgery. This effect appears to be largely mediated by reduction in weight and BMI.
摘要：
背景：减肥手术是肥胖的有效治疗方法，可以降低肥胖相关癌症的发病率和死亡率。
目的：我们调查了与筛查结肠镜对照相比，减重手术后Barrett食管（BE）新诊断的风险。
方法：大型国家数据库，包括在住院期间接受护理的患者，门诊病人,和专业护理服务。
方法：国家医疗保健数据库(TriNetX，LLC)用于此分析。病例包括接受袖状胃切除术（SG）或Roux-en-Y胃旁路术（RYGB）的成年人（年龄≥18岁）。对照组包括在同一天接受筛查结肠镜检查和食管十二指肠镜检查的成年人，并且从未接受过减肥手术。病例和对照组的混杂因素倾向匹配。在病例和对照组之间比较减肥手术后至少1年的BE从头诊断的风险。次要分析检查了减肥手术对代谢结果的影响，例如体重减轻和体重指数（BMI）。将SG中BE从头诊断的风险与RYGB进行比较。使用赔率比(OR)和95%CI报告这些关联。
结果：在倾向匹配分析中，与结肠镜检查筛查对照相比,接受过减肥手术的患者显示出从头BE的风险显著降低(.67[.48,.94]).与基线相比，减重手术组的体重和BMI显着降低。倾向匹配的SG组和RYGB组之间的从头BE诊断没有显着差异（.77[.5,1.2]）。
结论：接受减重手术（RYGB或SG）的患者与未接受减重手术的筛查结肠镜检查对照组相比，被诊断为BE的风险较低。这种效应似乎主要由体重和BMI的降低介导。
目的：我们调查了与筛查结肠镜对照相比，减重手术后Barrett食管（BE）新诊断的风险。
方法：大型国家数据库，包括在住院期间接受护理的患者，门诊病人,和专业护理服务。
方法：国家医疗保健数据库(TriNetX，LLC)用于此分析。病例包括接受袖状胃切除术（SG）或Roux-en-Y胃旁路术（RYGB）的成年人（年龄≥18岁）。对照组包括在同一天接受筛查结肠镜检查和食管十二指肠镜检查的成年人，并且从未接受过减肥手术。病例和对照组的混杂因素倾向匹配。在病例和对照组之间比较减肥手术后至少1年的BE从头诊断的风险。次要分析检查了减肥手术对代谢结果的影响，例如体重减轻和体重指数（BMI）。将SG中BE从头诊断的风险与RYGB进行比较。使用赔率比(OR)和95%CI报告这些关联。
结果：在倾向匹配分析中，与结肠镜检查筛查对照相比,接受过减肥手术的患者显示出从头BE的风险显著降低(.67[.48,.94]).与基线相比，减重手术组的体重和BMI显着降低。倾向匹配的SG组和RYGB组之间的从头BE诊断没有显着差异（.77[.5,1.2]）。
结论：接受减重手术（RYGB或SG）的患者与未接受减重手术的筛查结肠镜检查对照组相比，被诊断为BE的风险较低。这种效应似乎主要由体重和BMI的降低介导。
