Laparoscopic One Anastomosis Gastric Bypass Versus Laparoscopic Roux-en-Y Gastric Bypass Effects on Pre-existing Mild-to-Moderate Gastroesophageal Reflux Disease in Patients with Obesity: a Randomized Controlled Study

Eskandaros, Moheb S; Abbass, Alaa; Zaid, Mohamed H.; Darwish, Ahmed A.

doi:10.1007/s11695-021-05667-5

Cited by 23 publications

(11 citation statements)

References 37 publications

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“…Interestingly, the current study showed resolution of macroscopic esophagitis in all patients post-OAGB with no de novo development of macroscopic findings. 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 ].…”

Section: Discussionsupporting

confidence: 92%

“…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%

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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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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…Moreover, some authors proposed tailoring of the biliopancreatic limb in RYGB according to the BMI of the patients using a length of 60 cm if BMI < 45, 80 cm if BMI is between 45 and 50, and 100 cm if BMI > 50. Similarly, in OAGB, they proposed using a biliopancreatic limb length of 120 cm for BMI < 45, 200 cm for BMI between 45 and 50, and 220 cm for BMI > 50 [ 26 ]. In this study, we recorded excellent weight loss and nutritional laboratory values between the OAGB group with a 200-cm biliopancreatic limb length and the RYGB group with a biliopancreatic limb length of 100 cm combined with a 100-cm alimentary limb through 2 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Revisional Roux-en-Y Gastric Bypass Versus Revisional One-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy: a Randomized Controlled Trial

et al. 2022

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Background High rates of revision surgery have been reported for laparoscopic sleeve gastrectomy (LSG), with weight regain (WR) as the most frequently reported cause. Roux-en-Y gastric bypass (RYGB) is the most commonly performed revision procedure, whereas one-anastomosis gastric bypass (OAGB) is a less popular approach. Methods A single-blinded randomized controlled trial was conducted. One hundred seventy-six patients were enrolled and randomized. After loss to follow-up, 80 patients for RYGB and 80 patients for OAGB were analyzed, with a 2-year follow-up. Patients with grade B or higher gastroesophageal reflux disease (GERD) were excluded. Early and late postoperative complications were recorded. Body mass index (BMI), percentage of excess BMI loss (%EBMIL), nutritional laboratory test results, and the resolution of associated medical problems were assessed after revision surgery. Results After 2 years, both groups achieved significantly lower BMI than their post-LSG nadir BMI (p < 0.001). The %EBMIL changes showed significantly faster weight loss in the OAGB group than in the RYGB at the 6-month follow-up (mean difference: 8.5%, 95% confidence interval [CI]: 0.2 to 16.9%). However, at 1-year and 2-year follow-ups, the differences were statistically insignificant (p > 0.05). Early and late complications were similar between two groups. Both groups showed improvement or resolution of associated medical problems, with no statistically significant differences after 2 years (p = 1.00). Conclusion Both revisional RYGB and OAGB have comparable significant weight loss effects when performed for WR after LSG. After a 2-year follow-up, both procedures were safe, with no significant differences in the occurrence of complications and nutritional deficits. Graphical abstract

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“…RYGB improves some patients’ symptoms over time; however, the sample size was small and there are many subjective indicators; hence, the conclusion is not adequately reliable [ 21 ]. The study by Eskandaros et al showed that the alkaline reflux resulting from RYGB was significantly lower than that from OAGB only at 6 and 12 months, while the GERD, percentage of esophageal acid exposure time, and number of acid reflux were significantly improved; however, there were no significant differences between them [ 25 ]. Analysis of the reasons for the improvement of alkaline reflux in the initial stage of RYGB may be due to the establishment of a bypass and the direct entry of biliopancreatic juice into the jejunal output loop, which is not directly connected with the gastric cavity.…”

Section: Discussionmentioning

confidence: 99%

“…A total of eight prospective randomized controlled trials were included in our meta-analysis [20][21][22][23][24][25][26][27]. The papers were published between 2005 and 2022, and a total of 931 patients participated.…”

Section: Study Characteristics and Risk Of Biasmentioning

confidence: 99%

Efficacy and Safety of One Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass for Obesity: a Meta-analysis and Systematic Review

et al. 2022

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The objective of this review is to systematically review the efficacy and safety outcomes of one anastomosis gastric bypass (OAGB) with Roux-en-Y gastric bypass (RYGB). From inception to July 4, 2022, a systematic literature search was performed using PubMed, Embase, and Cochrane Library for randomized clinical trials comparing OAGB with RYGB in obesity. A meta-analysis performed using the RevMan 5.4.1 software evaluations was completed. We identified 1217 reports; after exclusions, eight trials with a total of 931 patients were eligible for analysis. Compared with RYGB, OAGB had multiple advantageous indexes. Examples include percent of excess weight loss (%EWL) at 12 months (P = 0.009), body mass index (BMI) at 2 years (P < 0.00001), early postoperative complication (P = 0.04), remission of dyslipidemia (P < 0.0001), and operative time (P < 0.00001). No significant statistical difference was observed in BMI at 6 months, %EWL at 6 months, BMI at 12 months, percent of excess body mass index loss (%EBMIL) at 2 years, BMI at 5 years, intraoperative complications, late postoperative complications, remission of type 2 diabetes mellitus, and dyslipidemia or gastroesophageal reflux disease remission between OAGB and RYGB. OAGB is no less effective than RYGB; no significant differences in weight loss efficacy were observed, and more large and long-term randomized controlled trials are needed to verify this. In addition, studies have shown that OAGB has a shorter operation time, fewer early postoperative complications, and a shorter learning curve, making it easier for young surgeons to perform.

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Laparoscopic One Anastomosis Gastric Bypass Versus Laparoscopic Roux-en-Y Gastric Bypass Effects on Pre-existing Mild-to-Moderate Gastroesophageal Reflux Disease in Patients with Obesity: a Randomized Controlled Study

Cited by 23 publications

References 37 publications

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

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

Revisional Roux-en-Y Gastric Bypass Versus Revisional One-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy: a Randomized Controlled Trial

Efficacy and Safety of One Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass for Obesity: a Meta-analysis and Systematic Review

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