[Bariatric surgery in obese patients with gastroesophageal reflux and/or Barrett’s esophagus]

Navarro E, Augustovski F, Colaci C, Alfie V, García Marti S, Bardach A, Alcaraz A, Pichon Riviere A
Record ID 32018004416
Original Title: Cirugía bariátrica en pacientes obesos con reflujo gastro-esofágico y/o esófago de Barrett
Authors' recommendations: Moderate-quality evidence shows that Roux-en-Y gastric bypass, compared with sleeve gastrectomy in obese patients with a Body Mass Index (BMI) ≤40 kg/m2 with comorbidities (Type II diabetes, arterial hypertension, dyslipidemia or obstructive sleep apneas, among others), who also have gastroesophageal reflux and/or Barrett’s esophagus, may likely experience a considerable net benefit because it reduces gastroesophageal reflux symptoms. However, postoperative complications are higher than with sleeve gastrectomy. Also, high quality evidence shows that Roux-en-Y gastric bypass is associated with an additional lower net benefit, given by weight loss, improvement in lipid panel and blood pressure. Most clinical practice guidelines and recommendations by scientific societies consulted consider bariatric surgery for obese patients (BMI ≤40 kg/m2 ), provided they have certain different comorbidities. However, they do no specifically include gastroesophageal reflux and/or Barrett’s esophagus among comorbidities for surgical indication; and none of them mentions or recommends any specific technique as preferred for patients with gastroesophageal reflux and/or Barrett’s esophagus. In the Latin American health policies analyzed, only the Brazilian public health sponsor covers Roux-en-Y gastric bypass for patients with a BMI of 35-40 kg/m2 with associated comorbidities. In Argentina, gastric bypass was included in the Mandatory Medical Plan only for patients with morbid obesity (BMI ≥40 kg/m2 ). The private United States sponsor, Cigna, considers gastrointestinal reflux as a comorbidity, favoring the bariatric surgery indication, which include Roux-en-Y gastric bypass for patients with a BMI of 35-39.9 kg/m2 . No studies assessing the cost-effectiveness or budget impact of this technology in Argentina were found, so this dimension was considered uncertain.
Project Status: Completed
Year Published: 2022
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Argentina
MeSH Terms
  • Obesity
  • Obesity, Morbid
  • Bariatric Surgery
  • Gastroesophageal Reflux
  • Barrett Esophagus
  • Gastrectomy
  • Gastric Bypass
Organisation Name: Institute for Clinical Effectiveness and Health Policy
Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA
Contact Name: info@iecs.org.ar
Contact Email: info@iecs.org.ar
Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)
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