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S828 Long-Term Risk of Gastrointestinal Malignancies Following Sleeve Gastrectomy Versus Gastric Bypass: A Comparative Safety Analysis
Abstract   Peer reviewed

S828 Long-Term Risk of Gastrointestinal Malignancies Following Sleeve Gastrectomy Versus Gastric Bypass: A Comparative Safety Analysis

Marina Takawy, Alexander Garza, Ghada Mohamed and Mohamad Mokadem
The American journal of gastroenterology, Vol.121(10S1), pp.S179-S179
10/01/2026
DOI: 10.14309/01.ajg.0001212564.13563.5e

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Abstract

Introduction: Obesity is a major global health concern, which is widely recognized as a contributing risk for many gastrointestinal (GI) malignancies. Sleeve gastrectomy and gastric bypass are the most commonly performed bariatric procedures. They have shown remarkable outcomes in achieving and sustaining weight loss and improving the cardiometabolic profile; however, studies comparing their long-term safety have been limited. Methods: We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network database. Adult patients with class III (morbid) obesity were identified and stratified into 2 cohorts: (1) patients who underwent sleeve gastrectomy and (2) patients who underwent Roux-en-Y gastric bypass (identified using CPT codes). Propensity score matching (PSM) (1:1) was performed using 15 covariates, including demographic characteristics, comorbidities, and family history, to achieve balanced baseline characteristics. The outcomes included risk of primary gastric, hepatic, pancreatic, colorectal (CRC) cancers through a long-term follow-up period of up to 10 years. Outcomes were expressed in relative risk (RR) with 95% confidence interval (CI). Results: 82,655 patients with sleeve gastrectomy and 51,289 patients with gastric bypass were identified. After PSM, 50,512 patients were included in each cohort. The mean follow-up duration was 1,585 days in sleeve group and 1786 days in bypass group. There was no difference in risk of gastric (RR = 0.81, 95% CI = 0.38–1.37, P = 0.42), pancreatic cancer (RR = 0.79, 95% CI = 0.54–1.17, P = 0.24), hepatocellular carcinoma (RR = 1.04, 95% CI = 0.61–1.76, P = 0.14) or CRC between the 2 groups (RR = 0.95, 95% CI = 0.75–1.21, P = 0.67). Conclusion: In a large population-based study, the risk of gastrointestinal malignancies was similar between patients undergoing sleeve gastrectomy and Roux-en-Y gastric bypass. These findings provide reassurance that neither procedure confers an increased long-term oncologic risk relative to the other, supporting current practice in which procedural choice is guided by patient-specific factors and comorbidity profiles rather than cancer risk alone.
 Gastrointestinal Surgery Weight control

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