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The Impact of Weight Loss on the Regression of Barrett’s Esophagus after Roux-en-Y Near Esophagojejunostomy as an Anti-reflux Operation

Zhang, Dongning (2021) The Impact of Weight Loss on the Regression of Barrett’s Esophagus after Roux-en-Y Near Esophagojejunostomy as an Anti-reflux Operation. Master Essay, University of Pittsburgh.

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Abstract

Objective: Gastroesophageal reflux (GERD), obesity and Barrett’s esophagus (BE) have been implicated in the dramatic rise in esophageal adenocarcinoma (EAC), particularly in western countries. Previous studies have shown that obesity correlates with GERD. Roux-en-Y gastric bypass (RNYGB) can address obesity and be effective as an anti-reflux procedure. We investigated our hypothesis that weight loss associated with RNYGB for GERD, may lead to regression of BE. Methods: This was a retrospective analysis of patients who underwent RNYGB as anti-reflux procedure. Patients with BMI25kg/m2 with biopsy-proven diagnosis of intestinal metaplasia (IM), confirmed endoscopic BE segment measurement, and post-operative surveillance endoscopy were included in the study. Pre-operative and post-operative weights at each follow-up endoscopic visit were recorded; post RNYGB weight loss was quantified using percent total weight loss, with 20%TWL within two years classified as successful weight loss. Events of BE regression were analyzed using survival analysis. Estimation of the BE regression events were obtained using the Kaplan-Meier estimator.v Results: We identified 29 patients that met all inclusion criteria. During median follow-up of 25 months, after RNYGB, 15 patients experienced regression. 14 patients did not. The regression group was significantly younger than the no-regression group (p=0.04), and had a trend towards having shorter preoperative BE segments and achieving greater %TWL within two years. There were no significant differences for other variables. Younger age and successful weight loss were found to significantly contribute to early BE regression. Conclusions: There was regression of BE in over 50% of patients who had undergone Roux-en Y for GERD. Successful weight loss and young age were associated with a trend in achieving early regression of BE. Future studies with a larger group of patients are necessary to further delineate the effects of RNYGB and weight loss on BE, and other factors associated with regression of BE. Public Health Relevance: Results of this study offer further evidence to update current practice guidelines in support of the use of RNYGB to manage GERD in the obese population by simultaneously addressing reflux and weight loss.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Zhang, Dongningdoz9@pitt.edudoz90000-0003-4085-8856
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairAwais, Omarawaiso@upmc.eduUNSPECIFIEDUNSPECIFIED
Committee MemberPennathur, Arjunarjunp@pitt.eduarjunpUNSPECIFIED
Committee MemberFinegold, Daviddnf@pitt.edudnfUNSPECIFIED
Date: 13 May 2021
Date Type: Completion
Submission Date: 28 April 2021
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 25
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Multidisciplinary MPH
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: Barrett's Esophagus, GERD, Gastric Bypass, Obesity, Esophageal Cancer, Weight Loss
Date Deposited: 13 May 2021 20:33
Last Modified: 13 May 2021 20:33
URI: http://d-scholarship.pitt.edu/id/eprint/40963

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  • The Impact of Weight Loss on the Regression of Barrett’s Esophagus after Roux-en-Y Near Esophagojejunostomy as an Anti-reflux Operation. (deposited 13 May 2021 20:33) [Currently Displayed]

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