Randomised controlled trialcited by the Tayebat archiveabstract only checked★ key study A-BAR-07 in-depth review
Finnish trial: sleeve vs bypass after 10 years
Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss, Comorbidities, and Reflux at 10 Years in Adult Patients With Obesity: The SLEEVEPASS Randomized Clinical Trial.
Overview
Salminen P et al.. JAMA Surg 2022 · PMID 35731535 · DOI 10.1001/jamasurg.2022.2229
Esophagitis was found in 31% after sleeve vs 7% after bypass; Barrett's esophagus was 4% in both groups.
Does the study support the specific claim? Partly · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Compare sleeve vs bypass
- How was the study done?
RCT with 10-year follow-up
- How many people, animals or samples were studied?
240 patients
- What was actually found?
More esophagitis after sleeve; Barrett's equal
- How large was the observed effect?
31% vs 7%; BE 4% vs 4%
- What do the results mean in everyday life?
Sleeve often causes reflux damage; bypass less so
- What are the study's limitations?
Attrition; small
- What does it say about Elawady's specific claim?
Supports reflux claim, not sleeve-specific Barrett's
- Do the results apply to Germany and Europe?
Directly European
- What can explicitly not be concluded from this study?
Cancer risk
Scientific in-depth review
1. Full reference
- Authors
- Salminen P, Grönroos S, Helmiö M, Hurme S, Juuti A, Juusela R, Peromaa-Haavisto P, Leivonen M, Nuutila P, Ovaska J
- Journal
- JAMA Surg
- Year
- 2022
- Identifier
- PMID 35731535 DOI 10.1001/jamasurg.2022.2229 · PMC9218929
- Verification
- verified – PubMed E-utilities efetch, 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
COI: not stated in record | Grants: none listed
2. Research question
10-year weight loss, comorbidity remission, GERD, esophagitis and Barrett's esophagus after LSG vs LRYGB
3. Study design and population
- Study design
- Randomised controlled trial – 10-year observational follow-up of a multicentre equivalence RCT (SLEEVEPASS), LSG vs LRYGB
- Population
Adults 18-60 with severe obesity (median BMI 44.6)
- Country
Finland
- Period
Surgery 2008-2010; follow-up to Jan 2021
- Sample size
240 randomized (121 LSG, 119 LRYGB); 176 had gastroscopy
- Inclusion and exclusion criteria
Age 18-60, severe obesity
4. Methods and endpoints
- Exposure / intervention
LSG
- Comparator
LRYGB
- Endpoints
%EWL; remission; GERD; esophagitis; Barrett's
- Statistical methods
Equivalence analysis; P values
5. Actual results
- Results
%EWL 43.5% LSG vs 50.7% LRYGB (difference 8.4 points favoring LRYGB). T2D remission 26% vs 33% (P=.63). Hypertension remission 8% vs 24% (P=.04). Esophagitis 31% LSG vs 7% LRYGB (P<.001). Barrett's esophagus 4% vs 4% (P=.29). Reoperation 15.7% vs 18.5%.
- Absolute risks
Esophagitis 31% vs 7%; Barrett's 4% in each arm
- Authors' conclusion
Both procedures gave good sustainable weight loss; esophagitis more prevalent after LSG, but cumulative incidence of BE was markedly lower than in previous trials and similar after both procedures.
6. Strengths
- Randomized
- 10-year endoscopic follow-up
7. Weaknesses
- 77% endoscopy completion
- No non-surgical arm
- Observational extension
8. Risk of bias
- Orienting tool
- RoB 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Attrition for endoscopy (23%); no blinding of endoscopists reported in abstract.
9. Assessment of the statistical interpretation
Strong difference in esophagitis; no difference in Barrett's.
10. Relevance to the specific claim
Key RCT for GERD/Barrett claims.
11. Independent contrary findings
Chandan meta-analysis (I-BAR-04) reports pooled de novo BE 5.6% after SG.
12. Transferability to Germany and Europe
Directly European.
13. Overall methodological judgement
High-quality evidence that sleeve increases esophagitis; does not show a sleeve-specific Barrett's excess.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | partly correct but over-interpreted |
14. Open questions
Long-term cancer risk.
15. Linked fact checks
- Sleeve gastrectomy substantially increases gastro-oesophageal reflux disease and erosive oesophagitis. – Studies supporting the claim
- After sleeve gastrectomy reflux is inevitable, and patients must take acid-suppressing drugs for life. – Studies contradicting or limiting the claim
- Sleeve gastrectomy leaves the oesophagus exposed to Barrett's oesophagus (archive: Barrett's in 4% at 10 years in SLEEVEPASS). – Studies contradicting or limiting the claim
- Sleeve gastrectomy is a physiologically wrong operation and a 'transgression against God's creation', because the stomach is not a bag but an endocrine, muscular and immune organ whose functions are lost. – Studies supporting the claim
- Gastric bypass is preferable to sleeve gastrectomy (less reflux) and can fully treat type 2 diabetes; for patients who fail dieting, bypass rather than sleeve should be chosen (2021 statement). – Studies supporting the claim
Use by the Tayebat archive
Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.
- What the archive says about the study
Esophagitis far more common after sleeve gastrectomy (31% vs 7% bypass), Barrett's esophagus in 4%; AR headline: Barrett's in 4% of sleeve patients.
- A. What was actually studied?
LSG vs LRYGB at 10 years
- B. What did the authors find?
Esophagitis 31% vs 7%; Barrett's 4% vs 4%
- C. What conclusions do the authors themselves draw?
Esophagitis more prevalent after LSG; BE markedly lower than earlier reports and similar after both
- D. What does the archive derive from it?
Used to show the sleeve leaves the esophagus exposed, including Barrett's.
- E. Is this derivation scientifically justified?
Esophagitis numbers correct. The EN finding says '4% of both procedures', but the narrative and AR headline present the 4% Barrett's rate as a sleeve-specific penalty. The authors stressed that BE was similar after both and lower than earlier reports.
- Adequacy of the interpretation (by the archive)
- partly correct but over-interpreted