Fear of Cancer After The Sleeve Gastrectomy

The Truth About Reflux After The Sleeve Gastrectomy


In my humble opinion and observance of patients over a period of working in the field of bariatrics for 13 years; in the rush to seek a quick fix operation to experience rapid weight loss many people overlook the negative side effects of the procedures.

gastric sleeve

It is recognised that some of the main complications of the sleeve gastrectomy and the gastric bypass are leaks and internal hernias but since the rise of the sleeve gastrectomy procedure some studies are showing a post sleeve acid reflux rate of between 20-30%. The question and concern is, that this form of acid reflux can be the cause of oesophageal cancer. So could this mean that in the weight loss surgery world we are creating a whole generation of sleeve patients with a lifetime risk of cancer?



In a recent edition of the Bariatric News Dr Robert Rutledge who has pioneered the mini gastric bypass procedure explains that a primary cause of gastric cancer is commonly caused by the bacteria H. Pylori and that patients who were likely infected were at a higher long term risk of developing gastric cancer. He advised that if surgeons are worried about gastric cancer they should look for Heliobacter Pylori and treat it appropriately. In his opinion the sleeve is creating moderate to severe acid reflux with oesophagitis in a moderate to large percentage of patients. General surgeons know that this is a pre-cancerous and potential cause of oesophageal cancer.




At the moment the data is limited for the gastric sleeve but in 20 years’ time we could see acid reflux rates as high as 50% so the question is patients considering the gastric sleeve procedure should be concerned about long term oesophagitis which is an unequivocal precursor to cancer.



Body Shape Impacts On Mortality

According to the findings of a large study published in the BMJ people who are lean for life have the lowest mortality, while those with a heavy body shape from childhood up to middle age have the highest mortality.



The paper entitled: Trajectory of body shape in early and middle life and all cause specific mortality: results from two prospective US cohort studies was led by a team of US researchers who tracked the evolution of body shape and associated mortality among two large cohort studies.

In total, 80,266 women and 36,622 men enrolled in the study recalling their weight at ages 5, 10,20, 30 and 40 years. They also provided body mass index at age 50, and were followed from age 60 over a median of 15-16 years for death. They answered detailed questionnaires on lifestyle and medical information every two years, and on diet every four years. Among the cohort fine distinct body shapes were identified from age 5-50: lean-stable, lean-moderate increase, lean-marked increased, medium-stable/increase, and heavy-stable/increase.



The results showed that people who remained stably lean throughout life had the lowest mortality, with a 15-year risk of death being 11.8% in women, and 20.3% in men. Those who reported being heavy as children and who remained heavy, or gained further weight, especially during middle age, had the highest mortality, with a 15-year risk of death being 19.7% in women and 24.1% in men.

“Our findings provide further scientific rationale for recommendations of weight management, especially avoidance of weight gain in midlife, for long term health benefit,” the author concluded.

In a second study, an international team of researchers found that increasing levels of BMI are associated with higher risk of premature death. It was expected that a higher BMI is associated with a reduced life expectancy, but the previous largest study showed that when compared to normal weight, overweight was associated with reduced mortality and only high levels obesity were associated with increased mortality.

The various limitations in the study such as smoking and prevalent or pre-diagnostic illness were not taken into account, both of which could lead to lower body weight, and increased mortality.

So, researchers in the current study sought to clarify this association by carrying out a large meta-analysis of 230 prospective studies with more than 3.74 million deaths among more than 30.3 million participants.

They analysed people who never smoked to rule out the effects of smoking, and the lowest mortality was observed in the BMI range 23-24 among this group. Lowest mortality was found in the BMI range 22-23 among healthy never smokers, excluding people with prevalent diseases. Among people who never smoked and studied over a longer duration of follow up of more than 20 and 25 years, where the influence of pre-diagnostic weight loss would be less, the lowest mortality was observed in the BMI range 20-22.

The findings of the study demonstrate the importance of smoking and health conditions in the association between BMI and mortality and reinforces concerns about the adverse effects of excess weight. There is an emphasis on the need to maintain a healthy weight although also a recognition that there are major challenges in finding effective ways to prevent weight gain, support weight loss and prevent further weight regain in both individuals and populations.