Sleeve & Band:Increased Risk of Esophageal

Cancer

Dr. Rutledge

Imagine; Your Post Op Pt

•Post Op Patient Visit"•"Dr., I found out the

operation that you performed on me may cause cancer."

•"You did not tell me this."•Your answer?

Sleeve & Band,

30% Reflux (2yr FU),

Leads to Esophageal Cancer

Dr. Rutledge

1. GE Reflux => Esophageal Cancer

Survey 120 Bariatric Surgeons

"GERD Increases Risk of Cancer of Esophagus. Longer GERD = More

Risk."

AGREE 100%

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,

•All patients had a pre- and postop swallow

•18% New-onset GERD on UGI •GERD score questionnaire, 22% New-onset GERD symptoms despite receiving daily Anti-Acid therapy

• Surg Obes Relat Dis. 2011 Nov-Dec: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

0

5

10

15

20

25

MOB RNY Sleeve Band

Pre op GE Reflux rate (%)

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5

10

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25

30

MOB RNY Sleeve Band

Postop GE Reflux rate (%)

Survey Bariatric Surgical Experts

0%

20%

40%

60%

80%

100%

Band Sleeve RNY MGB

GE Reflux is Common

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;

3. Band Sleeve => Increased Risk of Esophageal Cancer

4. Surgeons Should Warn Their Patients: Risk of Esophageal Cancer

after Band Sleeve

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?