The alteration in anatomy after metabolic bariatric surgery may lead to gastro-oesophageal reflux, oesophagitis, Barrett’s metaplasia and oesophageal adenocarcinoma

People with obesity may already have pre-existing reflux, changes in the distal oesophagus, Barrett’s oesophagus or adenocarcinoma

• Amongst patients with GORD there is a 5-12% risk of harbouring Barrett’s oesophagus

Also note that reflux/dyspepsia symptoms remain a poor predictor of abnormal findings

Thus it has been suggested that a pre-op Upper GI endoscopy be performed to check for various pathologies, which include hiatus hernia, oesophagitis, Barrett’s oesophagus, varices, gastritis, helicobacter, peptic ulcer disease

• Up to 25.3% of asymptomatic patients may have pathologies
• 0.2% of the procedures may be cancelled

Systematic review reported that

• The risk for Barrett’s oesophagus for patients presenting for metabolic bariatric surgery is 3.8%
• The denovo risk for Barrett’s oesophagus is 1.9% after metabolic bariatric surgery

Please note:

• Less than 1% of patients undergoing pre-op gastroscopy discovered to have any conditions that preclude metabolic bariatric surgery
  • Although 35% needed treatment and up to 23% change to a different bariatric operation
• The risk of Barrett’s oesophagus for the general population is 1-2%
• The risk for Barrett’s and malignancy after MBS is hypothetical
• Majority of the IFSO bariatric surgeons do not routinely offer upper GI endoscopy every 2-3 years despite the IFSO recommendations
• The time frame to develop Barrett’s oeosphagus is likely too be longer than 2 to 5 years after surgery

Hence some surgeons recommend gastroscopy

• After a sleeve gastrectomy at 1 year and every 2-3 years after that
• After one anastomosis gastric bypass to check for stomal ulcers or malignancy

Before MBS Assessment prior to metabolic bariatric surgery *For patients with known Barrett’s oesophagus and dysplasia is recommended to have therapy for the Barrett’s oesophagus such as ablation or endoscopic resection *For patients with long segment or dysplastic Barrett’s, a sleeve or OAGB may be contra indicated *It is recommended to have a baseline gastroscopy before MBS Studies: *The post op incidence of Barertt’s oeosphagus after MBS was estimated to be 2.4%, higher rates after a sleeve (2.86%), then OAGB (2.07%) and RYGBP (1.9%) *The post op incidence of Barrett’s oesophagus after a sleeve was 3.53%, followed by OAGB (3.5%) and RYGBP (1.7%) *One randomized control trial SLEEVEPASS reported de novo Barrett’s oesophagus for sleeve is 4%  and higher for RYGBP (4%) at 10 years follow up

After MBS   The rates of regression and progression of known Barrett’s oesophagus prior to MBS remain poorly defined   There is no evidence that MBS accelerates Barrett’s oesophagus progression to dysplasia and oesophageal adenocarcinoma even after a sleeve gastrectomy *However surveillance gastroscopy should be considered   The paucity of information on the progression and regression of Barrertt’s oeosphagus after sleeve, OAGB and RYGBP makes it difficult to provide strong recommendations on the relative appropriateness of different types of MBS procedures

IFSO recommendation in 2026 Please note this is a recommendation from IFSO, not clinical guidelines or protocols Some gastroenterologist or surgeons do not recommend all these steps   1. As symptoms are not an accurate predictor of pre-MBS pathology and/or susceptibility to post MBS GORD, upper GI endoscopy should be strongly considered prior to MBS   2. Upper GI endoscopy must be performed after MBS if patients develop alert symptoms such as dysphagia, odynophagia, weight loss, anaemia or GIT bleeding   3. Patients with incident or refractory GORD after MBS should undergo an upper GI endoscopy   4. Patients undergoing MBS with known Barrett’s oesophagus should remain on a surveillance program as recommended by the relevant national professional society   5. Patients living with GORD and/or Barrett’s oesophagus should be fully informed about the relative risks of the various MBS procedures to enable shared decision making   6. For patients with Barrett’s oesophagus, bypass procedures may be preferred   7. More research including registry studies needs to be undertaken to better delineate the impact of MBS on known Barrett’s oesophagus