Acid Reflux Is Common in Patients With Gastroesophageal Reflux Disease After One-Anastomosis Gastric Bypass

Nehmeh, William A; Baratte, Clement; Rives‐Lange, Claire; Martineau, Chloé; Boullenois, H.; Krivan, Sylvia; Guillet, Vincent; Gall, Maude Le; Cellier, Christophe; Carette, Claire; Czernichow, Sébastien; Chevallier, Jean‐Marc; Poghosyan, Tigran

doi:10.1007/s11695-021-05542-3

Cited by 23 publications

(13 citation statements)

References 27 publications

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“…Among the long-term complications, reflux that is resistant to medical treatment is possible and is usually treated with conversion to RYGB; even for this complication, no significant differences were found between the three groups. The decision to convert the OAGB for reflux resistant to medical treatment is based not only on esophageal impedance PH testing [38], but on a complete assessment also including computed tomography with oral contrast ingestion and upper gastrointestinal endoscopy. In our experience, conversion to RYGB was effective in > 90% of patients [36].…”

Section: Discussionmentioning

confidence: 99%

Revisional One Anastomosis Gastric Bypass with a 150-cm Biliopancreatic Limb After Failure of Adjustable Gastric Banding: Mid-Term Outcomes and Comparison Between One- and Two-Stage Approaches

Petrucciani¹,

Martini

Benois

et al. 2021

OBES SURG

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Purpose Laparoscopic adjustable gastric banding (LAGB) was a common procedure worldwide but associated with a high rate of long-term failure. This study aims to evaluate the safety and effectiveness of conversion to one anastomosis gastric bypass (OAGB) after failed LAGB. Materials and Methods We undertook a retrospective analysis of a prospectively maintained database in a tertiary referral center for bariatric surgery. All cases of revisional OAGB with a biliopancreatic limb (BPL) of 150 cm after failed LAGB performed between 2010 and 2016 were analyzed. Results Overall, 215 patients underwent conversion from LAGB to OAGB. Indication for surgery was primary weight loss (WL) failure in 30.7% of cases and long-term complications in the remaining patients, with or without associated weight regain. At the time of OAGB, the mean age was 43.2 ± 10.5 years and the mean BMI was 42 ± 6.9. Overall postoperative morbidity was 13.5%. The postoperative abscess ± leak rate was 5.9% in the overall population. Two years after OAGB, 9.7% of patients were lost to follow-up, % excess weight loss (EWL) was 88.2 ± 23.9, and % total weight loss (TWL) was 38.7 ± 9.3. At 5 years, 16.6% of patients were lost to follow-up, %EWL was 82.4 ± 25, and %TWL was 36.1 ± 10. There was no statistical difference in complication rates or WL results between the one-stage and two-stage approaches. Conclusion OAGB with a 150-cm BPL represents a safe and effective option after failed LAGB. Both synchronous OAGB and two-step revisional OAGB guarantee satisfying results in terms of postoperative morbidity and WL outcomes. Graphical abstract (PLEASE CORRECT THE GRAPHICAL ABSTRACT !!! 215 PATIENTS INSTEAD OF 250

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Section: Discussionmentioning

confidence: 99%

Revisional One Anastomosis Gastric Bypass with a 150-cm Biliopancreatic Limb After Failure of Adjustable Gastric Banding: Mid-Term Outcomes and Comparison Between One- and Two-Stage Approaches

Petrucciani¹,

Martini

Benois

et al. 2021

OBES SURG

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“…PPI administration is a standard treatment for acid reflux but in no way effective on non-acid reflux. For the first time, the presence of acid reflux in nearly one out of two patients with GERD post OAGB was clearly demonstrated with pH-impedance monitoring data collected and published in a recent study [ 12 ]. In this study, 30.23% of patients with acid reflux and 11.64% with mixed reflux (acid and bile) were documented, whereas only 27.9% of patients presented with pure bile (non-acid) reflux.…”

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confidence: 99%

“…The main hypothesis to date is that of bile origin [ 9 ]. Its role in the genesis of gastritis, esophagitis, anastomotic ulcer, as well as gastric and esophageal cancer has been pointed out in several studies [ 10 , 11 , 12 ]. To begin with, it is essential to understand the mechanism of post-OAGB bile reflux occurrence, as there is confusion in the literature regarding its definition.…”

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confidence: 99%

“…However, just the presence of bile in the gastric pouch is not synonymous with GERD. The main predisposing factor in the development of GERD is the congenital or acquired insufficiency of the lower esophageal sphincter [ 12 ]. In case of lower esophageal sphincter insufficiency, bile backflows in the esophagus and promotes GERD symptoms.…”

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confidence: 99%

“…In this study, 30.23% of patients with acid reflux and 11.64% with mixed reflux (acid and bile) were documented, whereas only 27.9% of patients presented with pure bile (non-acid) reflux. Among patients with pure acid reflux, median DeMeester score and distal esophageal acid exposure time (pH < 4) were 48.95 and 9.65%, respectively, confirming that OAGB patients may be exposed to acidity [ 12 ]. The main hypothesis for the development of acid reflux is related to the excess fundal tissue of the gastric pouch responsible for acid secretion by parietal cells.…”

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confidence: 99%

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