Postoperative Clinical-Endoscopic Follow-up for GERD and Gastritis After One Anastomosis Gastric Bypass for Morbid Obesi
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Postoperative Clinical-Endoscopic Follow-up for GERD and Gastritis After One Anastomosis Gastric Bypass for Morbid Obesity: How, When, and Why Francesco Pizza 1 & Dario D’Antonio 1 & Francesco Saverio Lucido 2 & Salvatore Tolone 2 & Chiara Dell’Isola 3 & Claudio Gambardella 2 Received: 21 April 2020 / Revised: 17 June 2020 / Accepted: 19 June 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction The one anastomosis gastric bypass (OAGB) is a widely diffused surgical procedure for morbid obesity. Several studies considered OAGB at risk for biliary reflux and anastomotic ulcers. The aim of the study was to evaluate gastroesophageal reflux disease (GERD) and esophagitis/gastritis rate after OAGB diagnosed by upper endoscopy (UE), comparing the results with GERD-Health-Related Quality of Life (HRQL) score. Methods From July 2014 to February 2019, patients underwent OAGB with at least 12-month follow-up were retrospectively evaluated. Clinical evaluation was associated with GERD-HRQL scoring. UE with a mucosal biopsy was also performed. A comparison among clinical scores and endoscopic findings was performed. Results Two hundred forty-one patients were analyzed in the study. Anthropometric features (BMI, %Excess weight loss, %Total weight loss) were significantly improved. Only 30% of patients with GERD-HQRL>30 showed esophagitis at UE: 11/181 (6.1%) showed grade A erosive esophagitis, 2/181 (1.1%) grade B esophagitis, whereas no patient resulted in grade C/D. Fifty-two patients (28.7%) showed endoscopic remnant gastritis of at least grade 1, with histological gastritis of at least mild grade in 70/181 patients (38.7%). Conclusion OAGB is a feasible and effective procedure in terms of weight reduction and comorbidities control, but controversies remain about the long-term onset of GERD and bile reflux. The incidence of esophagitis was increased after OAGB. However, the severity and incidence were lower compared to sleeve gastrectomy. Conversely, the incidence of gastritis, ileo-gastric anastomotic inflammation, and HP positivity were not negligible, suggesting the potential benefits of endoscopic surveillance after OAGB. Keywords One anastomosis gastric bypass . Obesity surgery . GERD . Gastritis . Esophagitis
Introduction The one anastomosis gastric bypass (OAGB) has gained a widespread diffusion among bariatric surgeons. It is the third
* Francesco Pizza [email protected] 1
Division of General and Emergency Surgery, Asl Napoli 2 nord, Frattamaggiore, Naples, Italy
2
Division of General, Mininvasive and Bariatric Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
3
AORN “dei Colli” Monaldi-Cotugno_CTO Department of Infectious Diseases, Naples, Italy
commonest bariatric procedure worldwide performed after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) [1], which found many supporters but still numerous criticisms for the concerns related to biliary reflux and malabsorption with consequent nutritional deficits.
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