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Long-Term Evaluation of Biliary Reflux on Esogastric Mucosae after One-Anastomosis Gastric Bypass and Esojejunostomy in Rats

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Abstract

Background

One-anastomosis gastric bypass/mini-gastric bypass (OAGB/MGB) remains controversial because it may cause chronic biliary reflux (BR). The risk of developing esogastric cancer due to BR after OAGB/MGB is based on the results of experimental rat studies using esojejunostomy (EJ). The aim of this study was to analyze the potential long-term consequences of BR on the esogastric mucosae in OAGB/MGB-operated rats and to compare these results to those from the use of EJ.

Methods

Wistar rats received OAGB/MGB (n = 16), EJ (n = 16), and sham (n = 8) operations. Mortality and weight changes were evaluated throughout the experiment. BR was measured using magnetic resonance imaging (MRI). Rats received follow-ups for 30 weeks. A double-blinded histological analysis was performed in the esogastric segments.

Results

BR was diagnosed in OAGB/MGB and EJ rats using the MRI technique; no BR occurred in the sham group. After a 30-week follow-up, no incidences of dysplasia or cancer were observed in the three groups. Additionally, esophageal intestinal metaplasia and mucosal ulcerations were observed in 41.7% and 50% of EJ rats, respectively, and no incidences of these conditions were observed in OAGB/MGB and sham rats. The incidence of esophagitis was significantly higher and more severe in the EJ group compared to those in the OAGB/MGB and sham groups (EJ = 100%, OAGB/MGB = 16.7%, sham = 8.3%; p < 0.001).

Conclusions

After a 30-week follow-up period, OAGB/MGB rats did not develop any precancerous or cancerous lesions when more than 40% of EJ rats had intestinal metaplasia.

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Authors and Affiliations

  1. General and Digestive Surgery Unit, Georges Pompidou, AP-HP University Hospital, 20 Rue Leblanc, 75908, Paris Cedex 15, France

    Leïla M’Harzi, Jean-Marc Chevallier, Guillaume Levenson, Tigran Poghosyan, Richard Douard & Matthieu Bruzzi

  2. INSERM 970, Équipe 2, PARCC, HEGP, Paris, France

    Leïla M’Harzi, Jean-Marc Chevallier, Anais Certain, Gwennhaël Autret, Guillaume Levenson, David Louis, Tigran Poghosyan, Arthur Berger, Gabriel Rahmi, Chloé Broudin, Olivier Clément, Richard Douard, Bertrand Tavitian & Matthieu Bruzzi

  3. Department of Hepato-gastroenterology and Endoscopy, Georges Pompidou, AP-HP University Hospital, 20 Rue Leblanc, 75908, Paris Cedex 15, France

    Arthur Berger & Gabriel Rahmi

  4. Department of Pathology, Georges Pompidou, AP-HP University Hospital, 20 Rue Leblanc, 75908, Paris Cedex 15, France

    Chloé Broudin

  5. Department of Radiology, Georges Pompidou, AP-HP University Hospital, 20 Rue Leblanc, 75908, Paris Cedex 15, France

    Olivier Clément

  6. Service de chirurgie générale et digestive, Hôpital européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France

    Matthieu Bruzzi

Authors
  1. Leïla M’Harzi
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  2. Jean-Marc Chevallier
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Contributions

Leïla M’Harzi, Jean-Marc Chevallier, Gabriel Rahmi, Olivier Clement, Richard Douard, Bertrand Tavitian, and Matthieu Bruzzi designed the experiments.

Leïla M’Harzi, Anais Certain, Gwennhael Autret, Guillaume Levenson, and Matthieu Bruzzi performed the experiments.

Leïla M’Harzi and Matthieu Bruzzi performed animal surgeries.

Gwennhael Autret, Olivier Clement, and Bertrand Tavitian supervised radiologic analyses.

Anais Certain and Chloe Broudin supervised histologic analyses.

Leïla M’Harzi, Gwennhael Autret, David Louis, Tigran Poghosyan, Arthur Berger, Gabriel Rahmi, Olivier Clement, Richard Douard, Bertrand Tavitian, and Matthieu Bruzzi analyzed and interpreted data.

Leila M’Harzi and Matthieu Bruzzi wrote the manuscript with comments from Jean-Marc Chevallier, Tigran Poghosyan, Gabriel Rahmi, Richard Douard, and Bertrand Tavitian.

Corresponding author

Correspondence to Matthieu Bruzzi.

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The authors declare that they have no conflict of interest.

Ethical Approval

All applicable institutional and/or national guidelines for the care and use of animals were followed. All experiments were performed in compliance with the European Community guidelines and approved by the Institutional Animal Care and Use Committee.

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M’Harzi, L., Chevallier, JM., Certain, A. et al. Long-Term Evaluation of Biliary Reflux on Esogastric Mucosae after One-Anastomosis Gastric Bypass and Esojejunostomy in Rats. OBES SURG 30, 2598–2605 (2020). https://doi.org/10.1007/s11695-020-04521-4

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