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Endoscopic and histopathological assessment of individuals undergoing one anastomosis gastric bypass: a 2-year follow-up

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Abstract

Background

There is much debate over the occurrence of biliary reflux to the gastric pouch after one anastomosis gastric bypass (OAGB) and its potential risks.

Objective

To assess endoscopic and histopathological findings following a standardized protocol of biopsy collection two years after OAGB.

Methods

A historical cohort study was conducted, based on a prospectively collected database, which involved 39 participants who underwent OAGB. Participants underwent clinical evaluation and esophagogastroduodenoscopy at the time of surgery and 24 months afterward. Post-operatively, biopsy specimens in esophagogastric junction, pouch, and anastomosis were systematically collected.

Results

92.3% of the participants were female and the mean age was 37 ± 8.5 years. The mean body mass index (BMI) significantly decreased from 37.6 ± 5.7 kg/m2 to 27 ± 4.1 kg/m2 after 2 years (p < 0.001). The mean %TWL was 27.2 ± 10.5%. The prevalence of non-erosive gastritis significantly increased from 25.6 to 51.3% (p = 0.02). Erosive gastritis significantly decreased from 28.2 to 10.3% (p = 0.04). Four cases of marginal ulcers were identified (10.3%). The commonest histopathological finding was mild inflammation in 74.3% (esophagogastric junction), 58.9% (pouch), and 71.8% (anastomosis). There was one case of focal intestinal metaplasia in each site of interest and no cases of dysplasia or severe inflammation.

Conclusions

Using a standardized protocol of post-operative biopsy collection, low rates of severe endoscopic and histopathological abnormalities were observed two years after OAGB. Nevertheless, as most patients have histologically proven inflammation, bile in the gastric pouch, and endoscopic gastritis, long-term surveillance is essential because of the uncertain risk of these abnormalities.

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Funding

This study was supported by Scitech, which provided disposable trocars, staplers, and cartridges for the procedures performed in the study protocol.

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Authors and Affiliations

  1. Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brasil

    João Gabriel Romero Braga, Guilherme Hoverter Callejas, Felipe David Mendonça Chaim, Martinho Antonio Gestic, Murillo Pimentel Utrini, Francisco Callejas-Neto, Almino Cardoso Ramos, Elinton Adami Chaim & Everton Cazzo

  2. Unit of Digestive Endoscopy, State University of Campinas (UNICAMP), Campinas, Brazil

    Luigi Carlo da Silva Costa & Ciro Garcia Montes

  3. Rua Alexander Fleming, S/No, Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil

    Everton Cazzo

Authors
  1. João Gabriel Romero Braga
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  2. Guilherme Hoverter Callejas
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  3. Luigi Carlo da Silva Costa
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  8. Francisco Callejas-Neto
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  9. Almino Cardoso Ramos
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  10. Elinton Adami Chaim
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  11. Everton Cazzo
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Corresponding author

Correspondence to Everton Cazzo.

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Disclosure

João Gabriel Romero Braga, Guilherme Hoverter Callejas, Luigi Carlo da Silva Costa, Ciro Garcia Montes, Felipe David Mendonça Chaim, Martinho Antonio Gestic, Murillo Pimentel Utrini, Francisco Callejas-Neto, Almino Cardoso Ramos, Elinton Adami Chaim, and Everton Cazzo have no conflict of interest or financial ties to disclose.

Human and animal rights

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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Braga, J.G.R., Callejas, G.H., da Silva Costa, L.C. et al. Endoscopic and histopathological assessment of individuals undergoing one anastomosis gastric bypass: a 2-year follow-up. Surg Endosc 37, 3720–3727 (2023). https://doi.org/10.1007/s00464-023-09884-0

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