Esophageal adenocarcinoma after sleeve gastrectomy. Actual or potential threat? Italian series and literature review

Background:Sleeve gastrectomy (SG) leads to esophageal mucosal damage in an elevated percent-age of cases, configuring a clinical condition of Barrett’s esophagus (BE) in a proportion as high as15–18.8%. BE may rarely evolve into esophageal adenocarcinoma (EAC).Objectives:To raise awareness of BE as a precancerous lesion which may progress toward malig-nancy after this popular bariatric procedure.Setting:Bariatric referral centers, Italy.Methods:All patients referred to our bariatric center who developed an EAC after SG between 2012and 2019 were reviewed and consecutively included in this study. The available scientific literatureregarding this complication is additionally reviewed.Results:The 3 male patients comprised in this case series underwent laparoscopic SG between 2012and 2015 in different bariatric referral centers. Age and body mass index at baseline ranged from 21–54 years and 43.1–75.6 kg/m2, respectively. All patients were lost to follow-up early after surgery (3.761.4 months), and were diagnosed with EAC at a mean of 27.367.6 months after SG. The 4 re-ported cases in the scientific literature developed an EAC at a mean of 32.5623 months fromSG. Overall, a diagnosis of EAC was made approximately 30.3617.1 months postoperatively, whichseems relatively and worryingly early after surgery. Conclusion:Although the rate and probability of progression from BE to EAC is still not well defined,assuming that the rising popularity and execution of SG leads to a growth in the BE incidence, then thepreoperative identification and stratification of cancer risk factors in this subset of patients is stronglyencouraged. Clinical and endoscopic follow-ups are essential to allow for prevention and early diag-nosis and for epidemiologic data collection purposes.