Introduction: Barret’s esophagus (BE), a precursor to esophageal adenocarcinoma (EAC), has high prevalence of 0.5–2.0% & has increasing burden in the Western World. Although BE & EAC are associated with chronic reflux, their burden among bariatric population procedures is compelling domain for investigation. Among patients undergoing bariatric surgeries, we aimed to quantify the incidence & progression of BE & the overall risk of esophageal carcinogenesis. Methods: A systematic search from Cochrane, Embase, Google Scholar, Medline, PubMed, Scopus, & Web of Science identified bariatric surgical studies with discrete endoscopic & histological findings. The outcomes of interest included: patient demographics, type of bariatric procedure (classified as Group I: Roux-en-Y Gastric Bypass; II: Sleeve Gastrectomy; III: Biliopancreatic Diversion with Duodenal Switch; IV: Adjustable Gastric Banding), pre- & post-bariatric procedural endoscopic and histological findings. The burden of BE, EAC, BE progression was described as pooled incidence[95% confidence intervals] & meta-analysis was performed using a random-effects model. Results: 40 underwent systematic review & 35 studies were meta-analyzed. 119,908 eligible patients underwent bariatric surgeries & were included (Group I (n= 75,050), II (n= 14,704), III (n= 445), & IV (n= 29,709). Among 59,572 patients with normal baseline, the pooled incidence of BE after bariatric procedures was 1.1% (0.3%-1.9%; I2=0.0%) (Figure 1A). The BE incidence was higher among Group II: 1.4% (0.3%-1.9%; I2=0.1%) vs Group I: 1.0% (0.3%-2.1%; I2=0.1%), albeit statistically insignificant. The incidence of advanced neoplasia, i.e BE with high-grade dysplasia or EAC among the overall population was 0.2% (0.0%-1.0%; I2=0.0) whereas among screen-prevalent BE was 5.5%[0-16.2%; I2=0.0] (Figure 1B). No publication bias was observed among studies describing BE incidence (P=0.13) & progression (P=0.6) (Figure 1C). Conclusion: EAC has a projected 5-year survival of only 21.7% thus the aforementioned risk of esophageal carcinogenesis among pre-existing BE is not trivial & may warrant eradication therapy. Due to sparse controlled studies, the actual carcinogenesis risk from bariatric surgeries remains elusive. Currently, it is still unknown if the risk of bariatric endoscopic procedures carries the same risk of progression of BE as compared to their surgical counterparts. Future high-quality prospective studies are needed to guide in management of high-risk patients undergoing bariatric interventions.Figure 1.: (A) Pooled incidence of Barrett's Esophagus and Advanced neoplasia in Overall Population (B) Pooled incidence of Advanced neoplasia in Barrett's Esophagus Population (C) Publication bias assessment of studies describing BE incidence and progression.