It appears that Sleeve and Band surgeons Should warn their patients of the Long term risk of GERD and Increased Risk of Esophageal cancer and Institute appropriate follow up planning.

1. GASTROESOPHAGEAL REFLUX IS
COMMON AFTER BOTH SLEEVE AND
BAND;
GER IS PRECANCEROUS LESION;
A WARNING TO SURGEONS AND
PATIENTS: THE BAND AND SLEEVE MAY
LEAD TO GER AND ESOPHAGEAL CANCER
R Rutledge MD, Center for
Laparoscopic Obesity Surgery
Tel: +1-702 714 0011, E-mail:
drr@clos.net

2. Introduction
• The Link between gastroesophageal reflux (GER)
and esophageal cancer is undeniable.
• "There is a strong and causal relation between
gastroesophageal reflux and esophageal
adenocarcinoma."(1)
• Hundreds of other studies support this conclusion.
• Therefore an intervention that significantly
increases the rate and severity of GER can be
predicted to increase the frequency of esophageal
cancer.

3. Objectives
• To study this phenomenon we performed
a survey of 112 internationally recognized
experts on bariatric surgery to determine
their experiences and judgment related to
the development of GER following Sleeve
and Band

4. Results
• 112 surgeons with experience in over
39,000 cases from 23 countries
responded.
• 89% of surgeons reported that "GE Reflux
/ Nausea & Vomiting is Common" after
Band and
• 55.4% of surgeons agreed that "GE Reflux
/ Nausea & Vomiting is Common" after
sleeve gastrectomy.

5. Results
• When presented with this question:
• "GERD Increases Risk of Cancer of
Esophagus. Longer GERD = More Risk.
GERD can cause Barrett's = even higher
risk," from the American Cancer Society.
• With the reference for this quote provided
(2):
• 88.9% of surgeons Agreed (remarkably
11% disagreed?)

6. Results
• The 11% that disagreed were more likely
supporters of the Band and the Sleeve, (Good or
Adequate surgery 42.9% and 85.8%
respectively)
• When presented with question: "Numerous
Studies Now Show that the Band and the Sleeve
can increase acid reflux and be associated with
Barretts."
• With these 5 quoted references (3-7)
• 80% agreed but again remarkably 20%
Disagreed!

7. Results
• When asked for quantitative data on the incidence of
GER after Band or Sleeve, we asked surgeons
• what is the "Postop GE Reflux rate (%)" in Band patients.
• The surgeons reported that 26.5%, (over one quarter) of
Band patients, suffer GER post op and importantly this is
an increase from less than 10% reported with GER
preop.
• In Sleeve patients surgeons reported that the Pre op GE
Reflux rate (%) was 8% and post op increased to
27.7%post op

8. Conclusions
• Although some band and sleeve surgeons
may not agree
• GER is a recognized precursor to
esophageal cancer.

9. Conclusions
• In addition this survey data confirms other
publications that these restrictive and
obstructive procedures lead increase of
GER in at least 25% of patients.
• In one study chronic daily reflux symptoms
was associated with a 44 fold increase in
risk of esophageal cancer.

10. Conclusions
• It appears that
Sleeve and Band surgeons
Should warn their patients of the
Long term risk of GERD and
Increased Risk of
Esophageal cancer and
Institute appropriate follow up
planning.