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

Abstract

Background Sleeve gastrectomy has consistently been linked to gastroesophageal reflux disease and Barrett’s esophagus. At the same time, the long-term effects of glucagon-like peptide-1 receptor agonists, particularly short-acting agents such as liraglutide, are less well understood. We compared the incidence of Barrett’s esophagus and esophageal cancer among patients treated with liraglutide vs. those who underwent sleeve gastrectomy.

Methods We conducted a retrospective cohort study using a large electronic health record database. Adults with obesity treated with liraglutide were compared to those who underwent sleeve gastrectomy. Propensity score matching was used to balance demographics, comorbidities, medication use and body mass index. The primary outcome was the incidence of Barrett’s esophagus without dysplasia diagnosed 3 years or more after treatment. Secondary outcomes involved esophageal cancer and Barrett’s esophagus with dysplasia. Risk ratios (RR) and 95%
confidence intervals (CI) were calculated.

Results We analyzed 10,048 sleeve gastrectomy and 10,048 liraglutide patients. Barrett’s esophagus without dysplasia was more frequent in the sleeve (0.3%) than in the liraglutide (0.1%) group, with a risk difference of 0.2% (95%CI 0.1-0.3%) and RR 2.70 (95%CI 1.31-5.56). Barrett’s esophagus with dysplasia was also more common in the sleeve group (0.1% vs. 0%). No significant difference in esophageal cancer was observed.

Conclusions Sleeve gastrectomy is associated with a higher risk of Barrett’s esophagus compared to liraglutide, though esophageal cancer rates did not differ. Liraglutide may offer a safe option for patients at risk of esophageal complications.

Keywords Barrett’s esophagus, cancer, liraglutide, sleeve, obesity

Ann Gastroenterol 2026; 39 (3): 303-309