sleeve-band esophageal cancer
DESCRIPTION
Sleeve-Band Esophageal CancerTRANSCRIPT
Sleeve & Band:20-30% New Onset GERD
GERD =>Increased Risk of
Esophageal Cancer
Dr. Rutledge
Gastroesophageal reflux disease and sleeve gastrectomy
• USA
• Germany
• France
• Netherlands
• Many more...
Sleeve Gastrectomy Quickly Leads to New Onset GE Reflux & Weight Regain
• Analysis of conversion from SG to Roux-en-Y
• Time to Revision < 2 yrs
• 30% for "Severe Reflux"• Obes Surg. 2012 Sep 23. Results of Conversion from
Sleeve Gastrectomy to Roux-en-Y Gastric Bypass. Gautier T, Caen Cedex, France
Sleeve Revision for Weight Loss and Reflux
• 106 procedures for
• Insufficient weight loss or weight regain in 88 cases.
• *** Sixteen (15%) patients had severe gastroesophageal reflux
• Obes Facts. 2011, Failure of laparoscopic sleeve gastrectomy, Weiner RA Frankfurt, Germany.
Gastroesophageal reflux disease and sleeve gastrectomy USA
• Postoperatively, 49% complained of immediate (within 30 d) GERD symptoms,
• 47.2% had persistent GERD symptoms that lasted >1 month after LSG, and
• 33.8% of patients were taking medication specifically for GERD after LSG.
• Surg Obes Relat Dis. 2011 Gastroesophageal reflux disease and sleeve gastrectomy. Carter PR LaGrange, IL USA.
Gastroesophageal reflux disease and sleeve gastrectomy USA
• The most common symptoms were heartburn (46%),
• followed by heartburn associated with regurgitation (29.2%).
• Surg Obes Relat Dis. 2011 Gastroesophageal reflux disease and sleeve gastrectomy. Carter PR LaGrange, IL USA.
Gastroesophageal reflux disease and sleeve gastrectomy USA
• "LSG correlated with the persistence of GERD symptoms in patients with GERD preoperatively. "
• "Patients who did not have GERD preoperatively had an increased risk of postoperative GERD symptoms."
• Surg Obes Relat Dis. 2011 Gastroesophageal reflux disease and sleeve gastrectomy. Carter PR LaGrange, IL USA.
Revisional Surgery After Failed Sleeve Gastrectomy
• 416 pts 23 Revisions (5.5%) < 4 yrs
• For Reflux & Weight Loss Failure
• 23% complications• Obes Surg. 2012 Sep 22. Outcomes of Revisional
Surgery After Failed Sleeve Gastrectomy. van Rutte PW Eindhoven, The Netherlands.
Gastroesophageal reflux disease and sleeve gastrectomy
• Many studies designed to evaluate the outcome of reflux symptoms following conventional and surgical treatment of obesity.
• Among bariatric procedures, gastric sleeve and banded gastroplasty have been shown to worsen reflux symptoms in the postoperative setting.
• Curr Gastroenterol Rep. 2011 Jun, Obesity and GERD: pathophysiology and effect of bariatric surgery.Tutuian R. Bern, Switzerland.
Silastic® ring Sleeve Gastrectomy
• 33 SRSG Postop an increase in Erosive Esophagitis in the Silastic® ring Sleeve Gastrectomy group to 14 (45.2%)!!
• "After 1 year of follow-up, we observed a worsening evolution of Erosive Esophagitis in the SRSG group"
• Obes Surg. 2011 Feb Erosive esophagitis after bariatric surgery Miguel GP Vitória, ES, Brazil.
A Question
• We Know Esophageal Cancer Dangerous Deadly and Rising Rapidly
• We Know That Acid Reflux (GERD) Is a Strong Causative Factor in Esophageal Ca
• Numerous Studies Including the Sleeve Consensus Conference Show That Band and Sleeve Cause 20-30% New Onset GE Reflux
• Are The Sleeve And Band Pre-cancerous Lesions In Up To 1/4 Of Patients?
Imagine; Your Post Op Sleeve or Band Patient
• Post Op Patient Visit"
• "Dr. I found out the operation that you performed on me may cause cancer, esophageal cancer. You did not tell me this."
• Your answer?
• Do we need to warn our patients?
Sleeve & Band,
30% New Onset GE Reflux (2yr FU),
GE Reflux is a Major Risk Factor Esophageal Cancer
IFSO Varianational Committee Survey
Over 100 Surgeons from Around the World:
1. GE Reflux => Esophageal Cancer
Survey 120 Bariatric Surgeons
"GERD Increases Risk of Cancer of Esophagus. Longer GERD = More
Risk."
AGREE 100%
65. GERD Increases Risk of Cancer of Esophagus. Longer GERD = More
Risk.
• GERD can cause Barrett's = even higher risk, from the American Cancer Society.
• JAMA. 2002 Gastroesophageal reflux, barrett esophagus, and esophageal cancer: scientific review. Shaheen N,
• Survey 102 Surgeons 100% Agreement
• 66. Treating or Avoiding GERD may protect & prevent Barrett's & Esophageal cancer.
• 100% of Expert Bariatric Surgeons Agreed
Numerous Studies Now Show that the Band and the Sleeve can increase acid
reflux and be associated with Barretts & Esophageal Caner.
• Dis Esophagus. 2011 Jan;24(1):E8-10. Esophageal adenocarcinoma after laparoscopic gastric band placement for obesity Stauffer JA, Mathew J, Odell JA, Department of General Surgery, Mayo Clinic, Jacksonville, Florida, USA.
• Ann Surg. 2010 Aug;252(2):319-24. Long-term results of laparoscopic sleeve gastrectomy for obesity. Himpens J, Division of Bariatric Surgery, AZ St-Blasius, Kroonveldlaan, Dendermonde, Belgium.
• Obes Facts. 2011;4 Suppl 1:42-6. Epub 2011 Apr 4. Failure of laparoscopic sleeve gastrectomy--further procedure? Weiner RA, Theodoridou S, Weiner S. Department of Surgery, Krankenhaus Sachsenhausen, Frankfurt/M, Germany. [email protected]
• Surg Obes Relat Dis. 2011 Nov-Dec;7(6):709-13. Epub 2011 Aug 16. Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Howard DD, Caban AM, Cendan JC, Ben-David K. Department of Surgery, Minimally Invasive, Gastroesophageal and Bariatric Surgery Service, University of Florida, Gainesville, Florida 32610, USA.
• Obes Surg. 2010 Feb;20(2):244-6. Epub 2009 Dec 8, Barrett's esophagus: a late complication of laparoscopic adjustable gastric banding, Varela JE., Minimally Invasive and Bariatric Surgery, Washington University, 660 South Euclid, Box 8109, St Louis, MO 63110, USA. [email protected]
2. Band and Sleeve => 30% GE Reflux
"Sleeve gastrectomy produces an important decrease in LES pressure, which can cause reflux symptoms and esophagitis"
Obes Surg. 2010 Mar;20(3):357-62. Epub 2009 Dec 15.Manometric changes of the lower esophageal sphincter after sleevegastrectomy in obese patients.Braghetto I,
Gastroesophageal reflux after sleeve
• All patients had a pre- and postop swallow
•18% New-onset GERD on UGI • GERD score questionnaire, •22% New-onset GERD
symptoms • In spite receiving daily Anti-Acid Rx
• Surg Obes Relat Dis. 2011 Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Howard DD, University of Florida, Gainesville, Florida 32610, USA
0%
5%
10%
15%
20%
25%
30%
35%
Band Sleeve RNY MGB
Dyspepsia %
31%
22%
5%
6%
0%
20%
40%
60%
80%
100%
Band Sleeve RNY MG/OA
GE Reflux / Nausea & Vomiting is Common
93%
70%
7%
4%
Pe
rcen
t (%
)
0%
5%
10%
15%
20%
Band Sleeve RNY MGB
Pre op GE Reflux rate (%)
10%
11%
17%
19%
0%
5%
10%
15%
20%
25%
30%
Band Sleeve RNY MGB
Postop GE Reflux rate (%)
24%
27%
6%
4%
Risk of Esophageal Cancer?
Band & Sleeve
Esophageal carcinoma after band & sleeve
• Esophageal carcinoma after sleeve gastrectomy. Scheepers AF, Schoon EJ, Nienhuijs SW. Surg Obes Relat
Dis. 2011 Jul-Aug;
• Esophageal adenocarcinoma after laparoscopic gastric band placement for obesity. Stauffer JA, Mathew J, Odell JA. Dis Esophagus. 2011 Jan;
• Adenocarcinoma of the lower esophagus after placement of a gastric band. Korswagen LA, Schrama JG, Bruins Slot W, Hunfeld
MA. Obes Surg. 2009 Mar;
1. Esophageal Cancer Rapidly Rising in USA and Around the World
2. Acid Reflux is one of the leading preventable causes of Esophageal
Cancer
3. Band Sleeve => 30% New Onset Acid GE Reflux, Increased Risk of
Esophageal Cancer4. Surgeons Should Warn Their
Patients: Risk of Esophageal Cancer after Band Sleeve
5. Sleeve and Band Patients Need Lifetime monitoring for new onset
symptomatic and asymptomatic GE Reflux
Best Practices
• What happens,• When your sleeve patients find
that• They may be at increased risk for
Esophageal Cancer• Their surgeons could or should
have known about it • But Did Not Warn Them?