Long-Term Evaluation of Biliary Reflux on Esogastric Mucosae after One-Anastomosis Gastric Bypass and Esojejunostomy in
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ORIGINAL CONTRIBUTIONS
Long-Term Evaluation of Biliary Reflux on Esogastric Mucosae after One-Anastomosis Gastric Bypass and Esojejunostomy in Rats Leïla M’Harzi 1,2 & Jean-Marc Chevallier 1,2 & Anais Certain 2 & Gwennhaël Autret 2 & Guillaume Levenson 1,2 & David Louis 2 & Tigran Poghosyan 1,2 & Arthur Berger 2,3 & Gabriel Rahmi 2,3 & Chloé Broudin 2,4 & Olivier Clément 2,5 & Richard Douard 1,2 & Bertrand Tavitian 2 & Matthieu Bruzzi 1,2,6
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background One-anastomosis gastric bypass/mini-gastric bypass (OAGB/MGB) remains controversial because it may cause chronic biliary reflux (BR). The risk of developing esogastric cancer due to BR after OAGB/MGB is based on the results of experimental rat studies using esojejunostomy (EJ). The aim of this study was to analyze the potential long-term consequences of BR on the esogastric mucosae in OAGB/MGB-operated rats and to compare these results to those from the use of EJ. Methods Wistar rats received OAGB/MGB (n = 16), EJ (n = 16), and sham (n = 8) operations. Mortality and weight changes were evaluated throughout the experiment. BR was measured using magnetic resonance imaging (MRI). Rats received followups for 30 weeks. A double-blinded histological analysis was performed in the esogastric segments. Results BR was diagnosed in OAGB/MGB and EJ rats using the MRI technique; no BR occurred in the sham group. After a 30week follow-up, no incidences of dysplasia or cancer were observed in the three groups. Additionally, esophageal intestinal metaplasia and mucosal ulcerations were observed in 41.7% and 50% of EJ rats, respectively, and no incidences of these conditions were observed in OAGB/MGB and sham rats. The incidence of esophagitis was significantly higher and more severe in the EJ group compared to those in the OAGB/MGB and sham groups (EJ = 100%, OAGB/MGB = 16.7%, sham = 8.3%; p < 0.001). Conclusions After a 30-week follow-up period, OAGB/MGB rats did not develop any precancerous or cancerous lesions when more than 40% of EJ rats had intestinal metaplasia. Keywords Mini gastric bypass . One anastomosis gastric bypass . Biliary reflux . Cancer . Metaplasia . Morbid obesity . Bariatric surgery
Introduction * Matthieu Bruzzi [email protected] 1
General and Digestive Surgery Unit, Georges Pompidou, AP-HP University Hospital, 20 Rue Leblanc, 75908 Paris Cedex 15, France
2
INSERM 970, Équipe 2, PARCC, HEGP, Paris, France
3
Department of Hepato-gastroenterology and Endoscopy, Georges Pompidou, AP-HP University Hospital, 20 Rue Leblanc, 75908 Paris Cedex 15, France
4
Department of Pathology, Georges Pompidou, AP-HP University Hospital, 20 Rue Leblanc, 75908 Paris Cedex 15, France
5
Department of Radiology, Georges Pompidou, AP-HP University Hospital, 20 Rue Leblanc, 75908 Paris Cedex 15, France
6
Service de chirurgie générale et digestive, Hôpital européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
Morbid obesity is a major public health problem [1], and bariatric surge
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