Cohort studyindependent cross-checkabstract checked I-BAR-115 standard review

Sleeve vs a weight-loss drug: Barrett changes

Incidence of Barrett's esophagus and esophageal cancer following sleeve gastrectomy versus liraglutide therapy.

Overview

Butt et al.. Ann Gastroenterol 2026 · PMID 42164611 · DOI 10.20524/aog.2026.1058

Barrett changes were diagnosed in 0.3% after sleeve vs 0.1% with liraglutide; cancer did not differ.

Does the study support the specific claim? Partly · Methodological quality: low

Study explained simply

What did the researchers want to find out?: Compare BE after SG vs liraglutide
How was the study done?: Matched EHR cohort
How many people, animals or samples were studied?: 20,096
What was actually found?: BE 0.3% vs 0.1%
How large was the observed effect?: RR 2.70
What do the results mean in everyday life?: Small absolute increase
What are the study's limitations?: Detection bias
What does it say about Elawady's specific claim?: Supports a modest relative increase
Do the results apply to Germany and Europe?: US data
What can explicitly not be concluded from this study?: Cancer risk

Authors: Butt et al.
Journal: Ann Gastroenterol
Year: 2026
Identifier: PMID 42164611 DOI 10.20524/aog.2026.1058
Verification: verified – PubMed efetch 2026-10-26 + Crossref API
Retracted: no
Corrections: none
Extent checked: abstract only
Conflicts of interest and funding: COI statement (PubMed record): Conflict of Interest: None

Is Barrett oesophagus or oesophageal cancer more frequent after sleeve gastrectomy than with liraglutide therapy?

Study design: Cohort study – Retrospective propensity-matched cohort in an electronic health record database
Population: Adults with obesity treated with SG or liraglutide
Country: USA (EHR network; not specified in abstract)
Period: not stated in abstract
Sample size: 10,048 SG vs 10,048 liraglutide
Inclusion and exclusion criteria: Propensity matching on demographics, comorbidities, medication, BMI

Exposure / intervention: Sleeve gastrectomy
Comparator: Liraglutide
Endpoints: Non-dysplastic BE >=3 y after treatment; BE with dysplasia; oesophageal cancer
Statistical methods: Risk ratios with 95% CI

Results: BE without dysplasia 0.3% vs 0.1%; risk difference 0.2% (0.1-0.3%); RR 2.70 (1.31-5.56). BE with dysplasia 0.1% vs 0%. No significant difference in oesophageal cancer.
Absolute risks: Excess about 2 Barrett diagnoses per 1000 sleeve patients.
Authors' conclusion: SG is associated with higher BE risk compared with liraglutide; cancer rates did not differ.

Orienting tool: ROBINS-E
Type of assessment: simplified assessment (abstract only)
Full formal assessment: no
Overall risk of bias: high
Rationale: Detection bias: sleeve patients are more likely to undergo endoscopy.

NNH ~500 (stats/I-BAR-115_butt_2026.py); RR cannot be reproduced exactly from rounded percentages.

One of few comparisons with non-surgical patients; signals higher BE after sleeve but very small absolute numbers.

Surveillance bias likely.

US data.

Weak support for a relative BE increase; absolute risk small; no cancer difference.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	low
Risk of bias	high
Precision of results	low
Directness	direct
Reproducibility	unknown
Consistency with the overall evidence	mixed
Regional transferability	moderate
Adequacy of the interpretation (by the archive)	not applicable

Endoscopy-controlled comparison.