P1.001. Obesity and Metabolic Surgery: Association of Gastroesophageal Reflux Disease, Barrett's Esophagus, and Esophageal Adenocarcinoma With an Emphasis on Sleeve Gastrectomy

Abstract

Benign Disease: Gastro-Esophageal Reflux and Hiatal Hernia Obesity is a global epidemic associated with various comorbidities, including gastroesophageal reflux disease (GERD), Barrett's esophagus (BE), and esophageal adenocarcinoma. Surgical treatment of obesity, particularly sleeve gastrectomy (SG), has gained widespread popularity due to its efficacy in weight loss and metabolic improvement. However, SG presents a recognized refluxogenic profile, raising concerns about the development of de novo GERD, inflammatory changes in the esophageal mucosa, and potential progression to BE and esophageal cancer. This study consists of a narrative literature review based on articles published between 2020 and 2025, primarily retrieved from the PubMed and Medline databases. Prospective and retrospective studies, systematic reviews, and consensus statements addressing the relationship between obesity, bariatric surgery, GERD, Barrett's esophagus, and esophageal adenocarcinoma were analyzed, with a specific focus on sleeve gastrectomy The reviewed data demonstrate that SG is associated with an increased incidence of GERD and erosive esophagitis in the postoperative period compared with the preoperative state. The incidence of Barrett's esophagus after SG varies widely among studies, ranging from 1% to 27%, with mean values around 9% to 15%, with most cases classified as de novo and non-dysplastic. Despite the increased reflux, progression to esophageal adenocarcinoma remains rare, with incidence rates comparable to those of the general population, even in long-term follow-up studies. Methodological heterogeneity, limited follow-up duration, variability in surgical techniques, and lack of diagnostic standardization explain much of the discrepancy among published results. Recent evidence suggests that postoperative weight loss and metabolic improvement may exert a partial protective effect against neoplastic progression, despite increased exposure to acid and bile reflux. Sleeve gastrectomy is clearly associated with increased GERD and esophagitis; however, its relationship with the development of Barrett's esophagus and esophageal adenocarcinoma has not yet been definitively established. Careful preoperative evaluation, individualized selection of surgical technique, and targeted endoscopic follow-up, particularly in patients with risk factors, are recommended. Further prospective, population-based studies with long-term follow-up are required to better clarify the long-term risks of this surgical intervention.