Evaluation of reflux following sleeve gastrectomy and one anastomosis gastric bypass: 1-year results from a randomized o
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and Other Interventional Techniques
Evaluation of reflux following sleeve gastrectomy and one anastomosis gastric bypass: 1‑year results from a randomized open‑label controlled trial Mario Musella1 · Antonio Vitiello1 · Giovanna Berardi1 · Nunzio Velotti1 · Marcella Pesce2 · Giovanni Sarnelli2 Received: 20 May 2020 / Accepted: 17 November 2020 © The Author(s) 2020
Abstract Background Recent reports have demonstrated that de novo reflux and worsening of pre-existing symptoms occur after SG; concerns are still expressed about the risk of symptomatic biliary reflux gastritis and oesophagitis. The aim of our study was to investigate and compare the rate of postoperative acid and non-acid reflux following Mini-/One anastomosis gastric bypass (MGB/OAGB) and laparoscopic sleeve gastrectomy (LSG). Study design A prospective randomized open-label, controlled trial registered on clinicaltrial.gov (NCT number: NCT02987673) has been carried out to evaluate esophagogastric junction exposure to reflux in the first year after MGB/ OAGB and LSG using high impedance manometry, endoscopy, and a validated questionnaire. Results A total of 58 individuals were eventually enrolled in this trial and represented the per-protocol population (n = 28 MGB/OAGB, n = 30 LSG). No difference was found between the two groups in terms of demographic characteristics, PAGISYM score, acid exposure time percent of the esophagus (AET%), esophagitis, and other HRiM and MII-pH data at baseline. Comparing MII-pH outcomes of the two groups, AET% resulted significantly higher after LSG at 12 months. Endoscopic findings showed a significant increase of esophagitis ≥ B in the LSG group after 1 year; postoperative esophagitis ≥ B resulted also significantly worsened after LSG when compared to MGB/OAGB. Conclusion Since AET% and rate of esophagitis are significantly higher after LSG when compared to MGB/OAGB, this procedure should be preferred in case of preoperative subclinical reflux or low grade (A) esophagitis. Keywords Sleeve gastrectomy · Mini-bypass · One anastomosis gastric bypass · Gastroesophageal reflux · GERD
* Antonio Vitiello [email protected] Mario Musella [email protected] Giovanna Berardi [email protected] Nunzio Velotti [email protected] Marcella Pesce [email protected] Giovanni Sarnelli [email protected] 1
Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II” ‑ Via S. Pansini 5, 80131 Naples, Italy
Clinical Medicine and Surgery Department, Naples “Federico II” University, AOU “Federico II” ‑ Via S. Pansini 5, 80131 Naples, Italy
2
Gastroesophageal reflux disease (GERD) prevalence is significantly higher in morbidly obese patients than in the general population [1]. The excess of visceral fat causes an increase of the intra-abdominal pressure, which reduces the efficacy of the lower esophageal sphincter (LES) and often induces the development of hiatal hernia (HH) [2]. Subsequently, massive weight loss is recommendable (Reviewer#1, Q2) to improve
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