Evaluation of reflux following sleeve gastrectomy and one anastomosis gastric bypass: 1-year results from a randomized open-label controlled trial

Musella, Mario; Vitiello, Antonio; Berardi, Giovanna; Velotti, Nunzio; Pesce, Marcella; Sarnelli, Giovanni

doi:10.1007/s00464-020-08182-3

Cited by 37 publications

(13 citation statements)

References 67 publications

(76 reference statements)

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“…This has been investigated by Tolone et al They have demonstrated, using high-resolution impedance manometry, the pressure gradient between the sleeve-shaped stomach and the jejunum acts as an active pump facilitating the flow of the bile into the intestine, while the length of the pouch avoids reflux into the oesophagus [20]. Specifically, another randomized clinical trial has also demonstrated that AET% (acid-exposure time) and rate of esophagitis are significantly higher after LSG when compared to MGB/OAGB; therefore, this procedure should be preferred in case of preoperative subclinical reflux or low grade (A) esophagitis [21].…”

Section: Discussionmentioning

confidence: 99%

Revisional Surgery After One Anastomosis/Minigastric Bypass: an Italian Multi-institutional Survey

et al. 2022

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Background Efficacy and safety of OAGB/MGB (one anastomosis/mini gastric bypass) have been well documented both as primary and as revisional procedures. However, even after OAGB/MGB, revisional surgery is unavoidable in patients with surgical complications or insufficient weight loss. Methods A questionnaire asking for the total number and demographics of primary and revisional OAGB/MGBs performed between January 2006 and July 2020 was e-mailed to all S.I.C. OB centres of excellence (annual caseload > 100; 5-year follow-up > 50%). Each bariatric centre was asked to provide gender, age, preoperative body mass index (BMI) and obesity-related comorbidities, previous history of abdominal or bariatric surgery, indication for surgical revision of OAGB/MGB, type of revisional procedure, pre- and post-revisional BMI, peri- and post-operative complications, last follow-up (FU). Results Twenty-three bariatric centres (54.8%) responded to our survey reporting a total number of 8676 primary OAGB/MGBS and a follow-up of 62.42 ± 52.22 months. A total of 181 (2.08%) patients underwent revisional surgery: 82 (0.94%) were suffering from intractable DGER (duodeno-gastric-esophageal reflux), 42 (0.48%) were reoperated for weight regain, 16 (0.18%) had excessive weight loss and malnutrition, 12 (0.13%) had a marginal ulcer perforation, 10 (0.11%) had a gastro-gastric fistula, 20 (0.23%) had other causes of revision. Roux-en-Y gastric bypass (RYGB) was the most performed revisional procedure (109; 54%), followed by bilio-pancreatic limb elongation (19; 9.4%) and normal anatomy restoration (19; 9.4%). Conclusions Our findings demonstrate that there is acceptable revisional rate after OAGB/MGB and conversion to RYGB represents the most frequent choice. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Revisional Surgery After One Anastomosis/Minigastric Bypass: an Italian Multi-institutional Survey

et al. 2022

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“…The OAGB with a tailored limb length of about 200 cm has shown to achieve good weight loss for patients with BMIs over 50 kg/m 2 [38] and has shown superiority when compared to the SG [39][40][41]42]. A systematic review by Parmar et al reported mean %EWL of 90.75%, three years after OAGB patients with BMIs over 50 kg/m 2 [43].…”

Section: Discussionmentioning

confidence: 99%

The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons

et al. 2022

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Background Bariatric surgery in patients with BMI over 50 kg/m2 is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey. Methods An online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m2 was ideated by 15 bariatric surgeons from 9 different countries. The questionnaire was emailed to all members of the International Federation of Surgery for Obesity (IFSO). Responses were collected and analyzed by the authors. Results 789 bariatric surgeons from 73 countries participated in the survey. Most surgeons (89.9%) believed that metabolic/bariatric surgery (MBS) on patients with BMI over 50 kg/m2 should only be performed by expert bariatric surgeons. Half of the participants (55.3%) believed that weight loss must be encouraged before surgery and 42.6% of surgeons recommended an excess weight loss of at least 10%. However, only 3.6% of surgeons recommended the insertion of an Intragastric Balloon as bridge therapy before surgery. Sleeve Gastrectomy (SG) was considered the best choice for patients younger than 18 or older than 65 years old. SG and One Anastomosis Gastric Bypass were the most common procedures for individuals between 18 and 65 years. Half of the surgeons believed that a 2-stage approach should be offered to patients with BMI > 50 kg/m2, with SG being the first step. Postoperative thromboprophylaxis was recommended for 2 and 4 weeks by 37.8% and 37.7% of participants, respectively. Conclusion This survey demonstrated worldwide variations in bariatric surgery practice regarding patients with a BMI superior to 50 kg/m2. Careful analysis of these results is useful for identifying several areas for future research and consensus building.

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“…Roux-en-Y gastric bypass is lauded for ameliorating GERD post-operatively [ 20 ], mechanistically attributable to hastened gastric emptying through an unrestricted gastrojejunostomy [ 21 ]. Similarly, OAGB reduces GERD post-operatively, with reduced acid exposure time, and lower number of acidic reflux events on impedance pH demonstrated 12 months post-operatively [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with a recent randomised controlled trial demonstrating complete endoscopic regression of pre-operative Los Angeles grade A or B esophagitis in 90% of patients at 12-month post-OAGB [ 23 ]. The long, narrow gastric pouch and widely patent gastrojejunostomy proposed as likely mechanistic explanations [ 22 ]. Studies by Lasheen and Shenouda reported post-operative gastroesophagitis in 32.5% of patients at 9 months and 55% at 6 months, respectively; however, no comment was made about whether these findings were de novo post-operative findings or had been present pre-operatively [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Once in a Bile — the Incidence of Bile Reflux Post-Bariatric Surgery

et al. 2022

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Purpose Excellent metabolic improvement following one anastomosis gastric bypass (OAGB) remains compromised by the risk of esophageal bile reflux and theoretical carcinogenic potential. No ‘gold standard’ investigation exists for esophageal bile reflux, with diverse methods employed in the few studies evaluating it post-obesity surgery. As such, data on the incidence and severity of esophageal bile reflux is limited, with comparative studies lacking. This study aims to use specifically tailored biliary scintigraphy and upper gastrointestinal endoscopy protocols to evaluate esophageal bile reflux after OAGB, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Methods Fifty-eight participants underwent OAGB (20), SG (15) or RYGB (23) between November 2018 and July 2020. Pre-operative reflux symptom assessment and gastroscopy were performed and repeated post-operatively at 6 months along with biliary scintigraphy. Results Gastric reflux of bile was identified by biliary scintigraphy in 14 OAGB (70%), one RYGB (5%) and four SG participants (31%), with a mean of 2.9% (SD 1.5) reflux (% of total radioactivity). One participant (OAGB) demonstrated esophageal bile reflux. De novo macro- or microscopic gastroesophagitis occurred in 11 OAGB (58%), 8 SG (57%) and 7 RYGB (30%) participants. Thirteen participants had worsened reflux symptoms post-operatively (OAGB, 4; SG, 7; RYGB, 2). Scintigraphic esophageal bile reflux bore no statistical association with de novo gastroesophagitis or reflux symptoms. Conclusion Despite high incidence of gastric bile reflux post-OAGB, esophageal bile reflux is rare. With scarce literature of tumour development post-OAGB, frequent low-volume gastric bile reflux likely bears little clinical consequence; however, longer-term studies are needed. Clinical Trial Registry Australian New Zealand Clinical Trials Registry number ACTRN12618000806268. Graphical abstract

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Evaluation of reflux following sleeve gastrectomy and one anastomosis gastric bypass: 1-year results from a randomized open-label controlled trial

Cited by 37 publications

References 67 publications

Revisional Surgery After One Anastomosis/Minigastric Bypass: an Italian Multi-institutional Survey

Revisional Surgery After One Anastomosis/Minigastric Bypass: an Italian Multi-institutional Survey

The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons

Once in a Bile — the Incidence of Bile Reflux Post-Bariatric Surgery

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