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Bile Reflux Scintigraphy After Mini-Gastric Bypass

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Abstract

Background

Significant weight-loss and diabetes remission have been reported after mini-gastric bypass (MGB). Concern has been raised regarding postoperative bile reflux (BR), but it has not been demonstrated in previous studies. We set out to find out if BR is evident in hepatobiliary scintigraphy after MGB.

Methods

Nine consecutive patients, seven with type 2 diabetes, underwent MGB (15 cm gastric tube, 250–275 cm biliary limb) at our institution with a 12-month follow-up, with none lost to follow-up. Then, 10.7 months (8.6–13.0) after MGB, all patients underwent hepatobiliary scintigraphy and a reflux symptom questionnaire (GerdQ) was filled out. A gastroscopy with biopsies was done for all patients with a bile-reflux-positive scintigraphy.

Results

Mean age at operation was 56 years (41–65) and preoperative BMI 43.1 kg/m2 (34.2–54.6). Mean %EWL was 83.9 (49.5–128.3) at 12 months. Four patients reached diabetes remission and two became insulin-independent. Hepatobiliary scintigraphy showed a transient BR into the gastric tube for five patients. Bile tracer was found in the gastric tube at 23–58 min after the tracer injection and highest activity was 8% (1–8%) at 58 min. Bile tracer was not found in the esophagus of any of the patients. One patient with a positive scintigraphy in the gastric tube required re-operation. Two patients with reflux symptoms had a negative scintigraphy.

Conclusion

Our results indicate that transient bile reflux is common after MGB in the gastric tube, but not in the esophagus. The clinical relevance of bile reflux needs further studies.

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Authors and Affiliations

  1. Department of Abdominal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00029, Helsinki, HUS, Finland

    Tuure Saarinen & Anne Juuti

  2. Faculty of Medicine, University of Helsinki, Helsinki, Finland

    Tuure Saarinen

  3. Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Helsinki, Finland

    Jari Räsänen & Jarmo Salo

  4. Department of Nuclear Medicine, Helsinki University Hospital, Helsinki, Finland

    Antti Loimaala & Miia Pitkonen

  5. Department of Surgery, Central Hospital of Seinäjoki, Seinäjoki, Finland

    Marja Leivonen

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  1. Tuure Saarinen
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Correspondence to Tuure Saarinen.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Informed Consent

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

Ethical Approval

This study was approved by the surgical ethics committee of our institution.

Sources of Funding

This study was funded by Finnish governmental research funds (EVO).

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Saarinen, T., Räsänen, J., Salo, J. et al. Bile Reflux Scintigraphy After Mini-Gastric Bypass. OBES SURG 27, 2083–2089 (2017). https://doi.org/10.1007/s11695-017-2608-7

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  • DOI: https://doi.org/10.1007/s11695-017-2608-7

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