Abstract
Introduction
Laparoscopic single anastomosis gastric bypass (SAGB) is increasingly performed for morbidly obese patients.
Aim of Work
This pilot study aims primarily at evaluating the incidence of bile gastritis after SAGB. The occurrence of reflux oesophagitis and reflux symptoms were also assessed.
Patients and Methods
This study included 20 patients having no reflux symptoms. All patients underwent a SAGB as a primary bariatric procedure by a single surgeon. Patients included consented to have an upper GI endoscopy done at 6 months postoperatively. Gastric aspirate was sent for bilirubin level assessment. Gastric and esophageal biopsies were submitted for histopathology and campylobacter-like organism (CLO) test.
Results
In our study, the rate of bile gastritis was 30%. In 18 patients, the level of bilirubin in gastric aspirate seems to be related to the degree of mucosal inflammation. The remaining two patients had microscopic moderate to severe gastritis with normal aspirate bilirubin level. Two patients with bilirubin level in aspirate more than 20 mg/dl had severe oesophagitis, gastritis with erosions, and metaplasia. Relationship between bilirubin level and histopathological findings of gastric biopsy examination was statistically significant with a P value of 0.001.
Conclusion
The incidence of bile gastritis in this cohort is higher than reported in the literature, and this may be worrying. The correlation between endoscopic findings and patients’ symptoms is poor. Bilirubin level and pH in aspirate might be useful tools to confirm alkaline reflux. Its level might help to choose candidates for revision surgery after SAGB. This needs further validation with larger sample size.
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References
Consultation W. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i–xii, 1–253.
Pham TH, Hunter JG. Schwartz’s Principles of Surgery. In: Schwartz’s Principles of Surgery [Internet]. 2015. p. 1309–40.
Katzmarzyk PT, Craig CL, Bouchard C. Original article underweight, overweight and obesity. J Clin Epidemiol. 2001;54(9):916–20.
Von Lengerke T et al. General practitioners’ opportunities for preventing ill health in healthy vs morbid obese adults: a general population study on consultations. J Public Health (Bangkok). 2007;15(2):71–80.
Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg. Jun. 2001;11(3):276–80.
Musella M, Susa A, Greco F, De Luca M, Manno E, Di Stefano C, et al. The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multicenter review. Surg Endosc. 2014;28(1):156–63. https://doi.org/10.1007/s00464-013-3141-y.
Lee WJ, Ser KH, Lee YC, et al. Laparoscopic roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg. 2012;22(12):1827–34.
Lee W-J, Yu P-J, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242(1):20–8.
McCarthy HB et al. Gastritis after gastric bypass surgery. Surgery. 1985;98(1):68–71.
Wu C-C et al. Gastric cancer after mini-gastric bypass surgery: a case report and literature review. Asian J Endosc Surg. 2013;6(4):303–6.
Paré P, Meyer F, Armstrong D, Pyzyk M, Pericak D, Goeree R. Validation of the GSFQ, a self-administered symptom frequency questionnaire for patients with gastroesophageal reflux disease. Can J Gastroenterol. 2003;17(5):307–12.
N. A. Metheny, B. J. Stewart, L. Smith, H. Yan, M. Diebold, and R. E. Clouse, “pH and concentration of bilirubin in feeding tube aspirates as predictors of tube placement.,” Nurs. Res., vol. 48, no. 4, pp. 189–97.
Facchiano E, Iannelli A, Lucchese M. Internal hernia after mini-gastric bypass: myth or reality? J Visc Surg. 2016;153(3):231–2.
M. Bruzzi, C. Rau, T. Voron, M. Guenzi, A. Berger, and J.-M. Chevallier, “Single anastomosis or mini-gastric bypass: long-term results and quality of life after a 5-year follow-up,” Surg. Obes. Relat. Dis., vol. 11, no. 2, pp. 321–6.
Chakhtoura G, Zinzindohoué F, Ghanem Y, et al. Primary results of laparoscopic mini-gastric bypass in a French obesity-surgery specialized university hospital. Obes Surg. 2008;18(9):1130–3.
Kular KS, Manchanda N, Rutledge R. A 6-year experience with 1,054 mini-gastric bypasses-first study from Indian subcontinent. Obes Surg. 2014;24(9):1430–5.
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Ethical Approval Statement
The pilot study “Bile Gastritis following laparoscopic single anastomosis gastric bypass” has obtained ethical committee approval in March 2015 before starting to recruit patients. Ethical committee approval is a must before the start of any research project in Cairo University Hospitals.
Statement of Informed Consent
Informed consent was obtained from all individual participants included in the study.
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Shenouda, M.M., Harb, S.E., Mikhail, S.A.A. et al. Bile Gastritis Following Laparoscopic Single Anastomosis Gastric Bypass: Pilot Study to Assess Significance of Bilirubin Level in Gastric Aspirate. OBES SURG 28, 389–395 (2018). https://doi.org/10.1007/s11695-017-2885-1
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DOI: https://doi.org/10.1007/s11695-017-2885-1