To WeightWise Patients:
The American Society of Metabolic and Bariatric Surgery (ASMBS) has recommended that each person who has had Laparoscopic Sleeve Gastrectomy (LSG) or Duodenal Switch (DS) should have a screening EGD (upper GI scope) 3 years after their original surgery date.
After looking at all available data, it was determined that the risk of acid exposure to the lower esophagus is higher in patients who have had either of these procedures. Over time, acid exposure can lead to inflammation and ulcers in the lining of the esophagus. These changes can “convert” the esophageal lining to what looks like the stomach lining (which is much more resistant to acid exposure).
In medical terms this process is called metaplasia and is more commonly known as Barrett’s Esophagus. Sometimes this process can result in converting to abnormal cells which we call dysplasia. “Barrett’s Esophagus” and “Barrett’s Esophagus with Dysplasia” can increase the risk of esophageal cancer.
Putting together several studies, the rate of developing Barrett’s Esophagus was determined to be about 10%. Importantly though, no patients actually had dysplasia and there were no occurrences of Esophageal Cancer in these studies of post-LSG patients. That being said, dysplasia and then esophageal cancer may take an extended period of time to present itself. The rate of occurrence is low. In the general population, Barrett’s Esophagus has an annual occurrence of esophageal cancer is 0.19% per year (2 per 1000 cases). If low grade dysplasia occurs, the rate bumps up to 0.7% per year (7 per 1000 cases).
It should be emphasized that to date zero cases of esophageal cancer have been reported due to Barrett’s esophagus after either LSG or DS surgery.
In an overabundance of caution and until more high-quality long-term studies are available, the ASMBS recommends an EGD (upper GI scope) at 3 years post-op and every 5 years after that if no Barrett’s Esophagus is identified. If Barrett’s Esophagus is found, the patient should have an additional EGD every 2-3 years.
What do patients who have had a LSG or DS surgery need to do?
Our best estimate of the total number of operations we have done at WeightWise is about 8000 cases. Around half have been LSG’s or DS’s. Logistically, we could not accommodate this amount of EGD’s. We agree with the ASMBS recommendation that you contact your local GI specialist if you are at least 3 years post LSG or DS to schedule a screening EGD.
We have contacted several groups in the OKC / Tulsa area who are taking new appointments. If you do not have a GI doctor, please feel free to reach out to one of them. This list is not meant to be comprehensive, there may be other physicians covered by your insurance or local to you. Most GI doctors are scheduling consults 3-4 months out as of this writing.
Dr. Zach Smith
1000 N Lincoln Blvd #4000, Oklahoma City, OK 73104
St. Anthony Gastroenterology Group
535 N.W. Ninth St., Suite 205, Oklahoma City, OK 73102
Gastroenterology Specialists, Inc.
10210 E. 91st St. South, Tulsa, OK 74133