Estudos endoscópico e histológico prospectivos e sequenciais da bolsa gástrica em 130 pacientes obesos mórbidos submetidos à bypass gástrico em Y-de-Roux

Abstract

-Background -Roux-en-Y gastric bypass is the most common performed bariatric surgery. A small gastric pouch is created, leaving a narrow gastrojejunal anastomosis, with a long jejunal limb. Very little is known regarding the behavior of this pouch years after surgery. Aim -To determine through prospective sequential endoscopic studies the size of the gastric pouch, the diameter of the anastomosis, and the behavior of H. pylori infection after surgery. Methods -In 130 patients subjected to resectional gastric bypass, several routine sequential endoscopic (until 120 months) and histological evaluations of the gastric pouch were performed. Results -After surgery, a mean of 3.6 endoscopies/patient were performed. Macroscopically nearly 95% of the small gastric pouches were normal, and the main pathological finding was a marginal ulcer. Erosive esophagitis disappeared in 93% of the patients. There was no increase in the orocaudal size of the pouch during this period of observation. There was no dilatation of the diameter of gastrojejunal anastomosis. Near 54% of all patients had normal fundic mucosa, while 18% had chronic active gastritis, coincident with H. pylori infection. Five patients had intestinal metaplasia. Conclusion -Based on this sequential endoscopic evaluation, there was no increase in the orocaudal size of the gastric pouch nor increase in the diameter of the gastrojejunal anastomosis. H. pylori behavior was inconsistent and difficult to interpret. ABCDDV/878RESUMO -Racional -Bypass gástrico em Y-de-Roux é a operação bariátrica mais comumente realizada. Pequena bolsa gástrica é criada, deixando uma anastomose gastrojejunal estreita, com uma alça jejunal mais comprida.

Gastric and Jejunal Histopathological Changes in Patients Undergoing Bariatric Surgery

“…Other authors, analyzing the gastric pouch and the presence of HP, have found no association between the presence of HP and the gastric pouch or gastrojejunal anastomosis size. These authors concluded that the behavior of HP is inconsistent and difficult to interpret 9 .…”

New Insight Into an Effective Treatment of Marginal Ulceration After Roux-en-Y Gastric Bypass

“…After pouch creation, the mucosa remains normal where parietal cells are plentiful and the pouch does not dilate. 14,15 Because the pouch contains a small amount of gastric corpus, the total amount of acid secreted is small. 16,17 However, because parietal cells secrete approximately 150 mmol/L HCl (pH, ~0.8), the intrapouch pH is generally low.…”