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Clinical Endoscopic and Histologic Findings of a Long-Term Follow-Up (10.7 Years) After Roux-en-Y Laparoscopic Gastric Bypass: a Prospective Study

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Abstract

Introduction

Bariatric surgery, with laparoscopic Roux-en-Y gastric bypass (LYGB), is one of the most effective treatments for long-term weight loss. However, there are few publications concerning endoscopic evaluations at late control. The purpose was to evaluate the macroscopic and histological findings at the distal esophagus, gastric pouch, jejunal limb and the evolution of Barrett’s esophagus (BE) in the long term.

Methods

Cohort of 110 patients with obesity underwent LYGB in a university hospital. Several clinical, endoscopic and histological evaluations were performed after surgery. Exclusion criteria were previous bariatric procedure, hiatal hernia > 4 cm, BE with histological dysplasia and body mass index (BMI) > 50 kg/m2.

Results

Average age was 38.7 ± 9 years with 70% females. BMI averaged 39.6 ± 6 kg/m2. Follow-up was 10.7 ± 2 years, and 18 patients (16.4%) were lost. The total weight loss was 23.4 ± 7 kg. Erosive esophagitis, present in 33% of patients, decreased to 5%. After surgery, intestinal metaplasia regressed to cardial mucosa in 5 of 8 patients. One patient developed a short-segment BE. The level of control to gastroesophageal reflux disease (GERD) symptom control was 87% to responders (Visick I–II) and 13% to non-responders (Visick III–IV). An increase in dilated cardia type III was observed (p < 0.001). The length of the gastric pouch increased significantly after surgery (p < 0.001). Anastomotic ulcers healed at 6 months with proton pump inhibitor (PPI) use, without recurrence.

Conclusion

LYGB is a very effective surgical procedure to control symptoms of GERD and/or endoscopic erosive esophagitis. Besides, regression of Barrett’s mucosa to carditis occurred in 62%.

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Authors and Affiliations

  1. Department of Surgery, University Hospital, University of Chile, , Carlos Lorca Tobar#999, Independencia, Región Metropolitana, 8380000, Santiago, Chile

    Attila J Csendes, Deycies L Gaete & Bárbara M Carreño

  2. Faculty de Medicine, University Los Andes, Monseñor Álvaro del Portillo #12455, Las Condes, Región Metropolitana, 8380000, Santiago, Chile

    Benjamín Panza

Authors
  1. Attila J Csendes
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  2. Deycies L Gaete
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  3. Bárbara M Carreño
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  4. Benjamín Panza
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Corresponding author

Correspondence to Attila J Csendes.

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Ethics Approval

All human participants’ procedures were carried out in accordance with the guidelines of the Institutional and Ministerial Committee and in accordance with the Helsinki Declaration of 1961 and their subsequent 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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Key Points

Laparoscopic Roux-en-Y gastric bypass has a success rate of 89% to long-term

LYGB is a strong antireflux surgery with GERD symptoms in 6% of the patients

LYGB reduces reflux symptoms by 90% and erosive esophagitis

LYGB produce regression of Barrett’s Esophagus in 2/3 of the patients

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J Csendes, A., L Gaete, D., M Carreño, B. et al. Clinical Endoscopic and Histologic Findings of a Long-Term Follow-Up (10.7 Years) After Roux-en-Y Laparoscopic Gastric Bypass: a Prospective Study. OBES SURG 32, 2930–2937 (2022). https://doi.org/10.1007/s11695-022-06172-z

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