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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

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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 gastro-esophageal 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.

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Authors and Affiliations

  1. Division of General and Emergency Surgery, Asl Napoli 2 nord, Frattamaggiore, Naples, Italy

    Francesco Pizza & Dario D’Antonio

  2. Division of General, Mininvasive and Bariatric Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Francesco Saverio Lucido, Salvatore Tolone & Claudio Gambardella

  3. AORN “dei Colli” Monaldi-Cotugno_CTO Department of Infectious Diseases, Naples, Italy

    Chiara Dell’Isola

Authors
  1. Francesco Pizza
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  2. Dario D’Antonio
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  3. Francesco Saverio Lucido
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  4. Salvatore Tolone
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  5. Chiara Dell’Isola
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  6. Claudio Gambardella
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Contributions

Francesco Pizza: conceptualization, methodology, data curation, writing original draft preparation. Dario D’antonio: visualization, investigation. Salvatore Tolone: supervision. Francesco Saverio Lucido: software, validation. Chiara Dell’Isola and Cludio Gambardella: reviewing, editing.

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Correspondence to Francesco Pizza.

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The authors declare that they have no conflict of interest.

Ethical Approval Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Pizza, F., D’Antonio, D., Lucido, F.S. et al. Postoperative Clinical-Endoscopic Follow-up for GERD and Gastritis After One Anastomosis Gastric Bypass for Morbid Obesity: How, When, and Why. OBES SURG 30, 4391–4400 (2020). https://doi.org/10.1007/s11695-020-04805-9

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  • DOI: https://doi.org/10.1007/s11695-020-04805-9

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