Bariatric Surgery and Esophageal Adenocarcinoma

Esophageal adenocarcinoma is the fastest rising cancer in the US. Obesity, and GERD are well known risk factors for esophageal adenocarcinoma development. Weight loss surgery like sleeve gastrectomy and Roux-en-Y gastric bypass are effective solutions for both obesity and GERD. Therefore, obese patients undergoing gastric sleeve or gastric bypass surgery are expected to have lower incidence of esophageal adenocarcinoma. A recent population based cohort study published in SOARD (Surgery for Obesity and Related Diseases) shows the opposite. The article is titled “Esophageal adenocarcinoma after obesity surgery in a population-based cohort study”. John Maret-Ouda et al analyzed 34437 patients who underwent weight loss surgery between 1980 and 2012 in Sweden. 8 cases of esophageal adenocarcinoma occurred after weight loss surgery compared to 53 detected esophageal adenocarcinoma cases in 123695 obese individuals who did not undergo any obesity surgery. Using Cox regression, the authors demonstrated no difference in esophageal adenocarcinoma risk between obese patients who had weight loss surgery and those who did not.

The study is quite unique since esophageal adenocarcinoma is not well studied following bariatric surgery. However, this study has two major limitations that undermine its relevance and importance. The first limitation is related to the small number of esophageal adenocarcinoma cases resulting in limited statistical power. The second limitation is related to the fact that most esophageal adenocarcinoma cases occurred in Lap band and vertical banded gastroplasty patients. Both procedures are known to increase the risk of GERD. Nissen fundoplication surgery has been shown to cause Barrett esophagus regression. Both gastric bypass and sleeve gastrectomy are excellent anti-reflux procedures and should theoretically offer the same protective effect against Barrett’s esophagus and esophageal adenocarcinoma. In fact, obese patients with GERD or Barrett’s esophagus are best treated with an effective weight loss procedure like sleeve gastrectomy and Roux-en-Y gastric bypass. Gastric banding in the form of lap band and VBG are no longer offered due to poor weight loss results. Furthermore, lap band surgery alters the esophago-gastric motility in favor of acid reflux development. Therefore, lap band surgery may potentially increase the risk of esophageal adenocarcinoma.