Bile Reflux After One Anastomosis Gastric Bypass
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LETTER TO THE EDITOR
Bile Reflux After One Anastomosis Gastric Bypass Attila Csendes 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Dear Sir: I have read with great interest the article entitled “Bile reflux is a common finding in the gastric pouch after one anastomosis gastric bypass” [1]. I believe it is an extremely important and milestone article concerning this special topic, due to the fact that this operation has increased in the last years with publications reporting excellent short-term results. I would like to emphasize several aspects of this publication which deserve some comments: 1. It is a part of a prospective randomized study comparing OAGB with Roux-en-Y gastric bypass, reporting only the results 6 months after OAGB. They found that 32% of the patients showed a positive bile reflux into the gastric remnant. This finding is extremely important because it destroys many fake opinions concerning this surgical procedure. We published on 2017 [2] a review article reporting our concerns that this operation is similar to the Billroth II anastomosis with its adverse clinical effects and damage on esophageal and gastric mucosa. This opinion was based in my report [3] published in Annals of Surgery on 2009 [3],in which we determined the very late results (17 years) of a prospective randomized study comparing Billroth II and Roux-en-Y anastomosis in duodenal ulcer patients. We demonstrated that there was a significant difference in reflux symptom among both procedures (p < 0.02). Endoscopic findings at the distal esophagus showed erosive esophagitis and development of Barrett’s esophagus in 21% of patients with Billroth II compared with 3% after Roux-en-Y anastomosis. At the gastric remnant, endoscopic findings were normal in 100% after Roux-en-Y operations and only 18% after Billroth II (p < 0.02). Chronic atrophic gastritis was pres-
* Attila Csendes [email protected] 1
Clinical Hospital University of Chile, Santiago, Chile
ent in 10 and 40%, respectively. I hope that our article will be useful for the authors. In our review, we commented that several authors proposed a long and thin gastric tube postulating a highpressure system in order to favor gastric emptying, but not based on scientific evidences. Johnson [4] reported bile reflux in al almost 60% of the patients. We postulated that this topic is a real challenge to the surgeons interested in demonstrating the advantages of OAGB. The present article takes down all these previous hypothesis not based on scientific research. 2. Another important point of this report is the use of upper endoscopy early after surgery. Six months after operation, 40% had abnormal findings at endoscopy. For me this is crucial, because the great majority of the surgical groups do not perform routinely endoscopic controls of their patients submitted either to any bariatric procedure. We just published the 10-year follow-up of patients submitted to sleeve gastrectomy in whom we performed 3 endoscopic procedures: 1 month, 1–2 years, and 10 years aft
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