Long-Term Evaluation of Biliary Reflux After Experimental One-Anastomosis Gastric Bypass in Rats

Bruzzi, Matthieu; Duboc, Henri; Gronnier, Caroline; Rainteau, Dominique; Couvelard, Anne; Gall, Maude Le; Bado, André; Chevallier, Jean‐Marc

doi:10.1007/s11695-017-2577-x

Cited by 36 publications

(18 citation statements)

References 11 publications

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“…As of yet, only two published cases of esophageal or gastric cancer in patients post-OAGB have been published 20,21 but there are no published long-term endoscopic studies. We previously explored the middle-term consequences of OAGB-induced biliary reflux on rats after 16 weeks and did not report an increased risk for esogastric cancer 30 .…”

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confidence: 99%

Long-term consequences of one anastomosis gastric bypass on esogastric mucosa in a preclinical rat model

Siebert¹,

Ribeiro-Parenti²,

Nguyen³

et al. 2020

Sci Rep

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Although bariatric surgery is proven to sustain weight loss in morbidly obese patients, long-term adverse effects have yet to be fully characterized. This study compared the long-term consequences of two common forms of bariatric surgery: one-anastomosis gastric bypass (oAGB) and Roux-en-Y Gastric Bypass (RYGB) in a preclinical rat model. We evaluated the influence of biliopancreatic limb (BPL) length, malabsorption, and bile acid (BA) reflux on esogastric mucosa. After 30 weeks of follow-up, Wistar rats operated on RYGB, OAGB with a short BPL (15 cm, OAGB-15), or a long BPL (35 cm, OAGB-35), and unoperated rats exhibit no cases of esogastric cancer, metaplasia, dysplasia, or Barrett's esophagus. Compared to RYGB, OAGB-35 rats presented higher rate of esophagitis, fundic gastritis and perianastomotic foveolar hyperplasia. OAGB-35 rats also revealed the greatest weight loss and malabsorption. on the contrary, BA concentrations were the highest in the residual gastric pouch of OAGB-15 rats. Yet, no association could be established between the esogastric lesions and malabsorption, weight loss, or gastric bile acid concentrations. in conclusion, RYGB results in a better long-term outcome than OAGB, as chronic signs of biliary reflux or reactional gastritis were reported post-oAGB even after reducing the BpL length in a preclinical rat model. Bariatric surgery is widely accepted as a long-term effective treatment for morbid obesity and ensuing metabolic disorders 1. One anastomosis gastric bypass (OAGB) is a promising procedure, first reported in 1997 2. This intervention has been proven safe 2 with some studies even reporting a lower rate of post-operative morbidity compared to the gold standard, Roux-en-Y gastric bypass (RYGB) 3,4. Additionally, OAGB may be preferred to RYGB due to its convenient ability to be reversed 5 and revised 6. Its efficiency in terms of weight loss and control of comorbidities has been widely characterized in the last several decades 7-9 , prompting its potential as an improved alternative to RYGB 7. However, OAGB is still debated due to chronic risks associated with potential biliary reflux 10 on the esogastric tract. OAGB, as all Omega-loop surgical strategies, is characterized by the direct anastomosis of the biliopancreatic loop to the stomach, instead of interposing an alimentary loop as in the Roux-en-Y procedures. This anatomically exposes the esogastric tract to bile acids (BA). In rats, the negative consequences of Omega-loop surgical strategies are well known 11,12. Esojejunal or esoduodenal anastomoses have been reported as experimental models of

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confidence: 99%

Long-term consequences of one anastomosis gastric bypass on esogastric mucosa in a preclinical rat model

Siebert¹,

Ribeiro-Parenti²,

Nguyen³

et al. 2020

Sci Rep

Self Cite

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“…Analysis of the prevalence of cancer and BE after EJ surgeries must be performed after sufficient esophageal exposure to bile and enteral juices, at least 12 to 20 weeks [6,7] . In our experience of OAGB surgeries, no dysplasia, metaplasia or cancer were observed after a 16-week follow-up [5] . The lack of follow-up and control group prompts us to now evaluate OAGB and its consequences using 30-week and 50-week follow-ups [8] and compare these results to EJ surgeries (control group).…”

Section: Risk Of Cancer After Oagb and The Need For Experimental Studiesmentioning

confidence: 69%

“…A vicryl suture was passed behind the esophagus. Then, the gastric artery and the esophagus were separated [5,10] .…”

Section: Oagb Surgeriesmentioning

confidence: 99%

“…On the day of sacrifices, histology and molecular analysis on esophageal and gastric mucosae can be performed to analyze the prevalence of BE and cancer [5] .…”

Section: Risk Of Cancer After Oagb and The Need For Experimental Studiesmentioning

confidence: 99%

“…No studies on the risks of these for humans are currently available and research, including experimental studies, is needed to help answer this important question [4,5] . The risk of developing metaplasia [Barett's esophagus (BE)] or esophageal adenocarcinoma (EA) after omega loop montage mainly exists because of studies that analyzed surgical models in rats in which the gastro-duodenal or enteral contents were placed in direct contact with the esophageal mucosa [esophagojejunostomy (EJ)] [6,7] .…”

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confidence: 99%

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One anastomosis gastric bypass and esojejunostomy in rats: surgical techniques

M'Harzi¹,

Bruzzi²,

Chevallier³

et al. 2019

MIS

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One anastomosis gastric bypass (OAGB) is a popular bariatric procedure, but controversies remain regarding biliary reflux and the potential risk of cancer. Esophagojejunostomy (EJ) in rats is a validated and reproducible model for the development of metaplasia [Barett's esophagus (BE)] and esophageal adenocarcinoma (EA) with a minimal exposure of 12 to 20 weeks. We are analyzing the risks of BE and EA in an OAGB rat model and comparing these with the EJ rat model. The purpose of this study is to describe our OAGB and EJ techniques in rats that we used to evaluate biliary reflux and share our experience with scientists and the bariatric community. These operations are short and simple procedures with acceptable morbidity.

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Laparoscopic One-Anastomosis Gastric Bypass/Mini Gastric Bypass: Managing Late Complications (>30 Days)

Chevallier

Pacini²,

Arienzo³

2022

Obesity, Bariatric and Metabolic Surgery

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Long-Term Evaluation of Biliary Reflux After Experimental One-Anastomosis Gastric Bypass in Rats

Abstract: After a 16-week follow-up, this pilot study confirmed the good reproducibility of our OAGB rat model. OAGB rats had not developed any pre-cancerous or cancerous lesions. Further experimental studies with longer term follow-up are required.

Cited by 36 publications

References 11 publications

Long-term consequences of one anastomosis gastric bypass on esogastric mucosa in a preclinical rat model

Long-term consequences of one anastomosis gastric bypass on esogastric mucosa in a preclinical rat model

One anastomosis gastric bypass and esojejunostomy in rats: surgical techniques

Laparoscopic One-Anastomosis Gastric Bypass/Mini Gastric Bypass: Managing Late Complications (>30 Days)

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