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Modified Hepatobiliary Scintigraphy for the Diagnosis of Bile Reflux in One-Anastomosis Gastric Bypass Surgery: a Prospective Multicenter Study

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Abstract

Purpose

One-anastomosis gastric bypass (OAGB) is a relatively simple surgical procedure for those afflicted with severe obesity. Studies reported symptomatic biliary reflux gastritis and esophagitis as predominant complications. Hepatobiliary scintigraphy (HIDA) is the least invasive test for the diagnosis of bile reflux, with good sensitivity, patient tolerability, and reproducibility. The aim of this study was to define an optimized HIDA scintigraphy protocol for demonstrating bile reflux in post-OAGB patients.

Material and Methods

We conducted a prospective multicenter study. Patients after OAGB with dyspeptic complaints were included. All patients underwent HIDA scan with a dedicated protocol for demonstrating bile reflux; prevalence and severity were reported.

Results

Nineteen patients were included, 18 females and one male, with mean age of 41.8 years and mean time of 22.4 months from operation to the scan. Bile reflux into the gastric pouch was documented in 11 patients (53%). Reflux to the stomach pouch was severe in three patients (27%), moderate in two patients (18%), and mild in six patients (55%). Bile reflux into the esophagus was documented in four patients (21%), severe reflux in one patient (25%), and mild in the other three (75%). A correlation was found between complaints of vomiting, heartburn and regurgitation, and findings of esophagitis on gastroscopy in patients with vs. without reflux.

Conclusions

The tailored HIDA scan protocol detected bile reflux in more than half of the post-OAGB patients included in the study, with a high diagnostic sensitivity.

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Abbreviations

OAGB:

One-anastomosis gastric bypass

HIDA:

Hepatobiliary scintigraphy

BMI:

Body mass index

RYGB:

Roux-En-Y gastric bypass

DGER:

Duodenogastroesophageal reflux

SPECT:

Single-photon emission computerized tomography

CT:

Computed tomography

SD:

Standard deviation

OR:

Odds ratio

CI:

Confidence interval

PPI:

Proton pump inhibitors

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Acknowledgements

We would like to thank Mr. Akram Akawi, the head technologist in the Nuclear Medicine Department, for his contribution in the development of the scan protocol and his dedicated work in performing the scans.

Author information

Author notes

  1. Tawfik Khoury and Wisam Sbeit contributed equally to this study.

Authors and Affiliations

  1. Nuclear Medicine Department, Galilee Medical Center, 2210001, Nahariya, Israel

    Elite Arnon-Sheleg

  2. Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel

    Elite Arnon-Sheleg, Moaad Farraj, Amir Mari, Tawfik Khoury & Wisam Sbeit

  3. Department of Surgery, The Baruch Padeh Medical Center, 1528001, Tiberias, Israel

    Moaad Farraj

  4. Radiology Department, Galilee Medical Center, 2210001, Nahariya, Israel

    Samar Michael

  5. Gastroenterology Department, Nazareth Hospital, 16100, Nazareth, Israel

    Amir Mari

  6. Department of Gastroenterology, Galilee Medical Center, 2210001, Nahariya, Israel

    Tawfik Khoury & Wisam Sbeit

Authors
  1. Elite Arnon-Sheleg
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  2. Moaad Farraj
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  3. Samar Michael
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  4. Amir Mari
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  6. Wisam Sbeit
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Contributions

Elite Arnon-Sheleg, Tawfik Khoury, and Wisam Sbeit contributed to the study concept and design. Wisam Sbeit, Moaad Faraj, and Amir Mari contributed to patients’ recruitment. Tawfik Khoury and Samar Michael analyzed the data and wrote the first version of the manuscript. Elite Arnon-Sheleg, Tawfik Khoury, and Wisam Sbeit critically reviewed the manuscript for publication readiness. All authors approved the final version to be published.

Corresponding author

Correspondence to Tawfik Khoury.

Ethics declarations

Ethical Approval and Consent to Participate

The trial was reviewed by the operative ethics committee and approved by the scientific board of our institutions. The study was carried out according to the Helsinki Declaration and informed consent was obtained from all patients.

Conflict of Interest

The authors declare no competing interests.

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Key Points

-One-anastomosis gastric bypass (OAGB) surgery is increasingly used for bariatric surgery.

-Few studies suggest its association with bile reflux; to date, there is no standard, well-tolerated study used to diagnose bile reflux.

-Our novel HIDA protocol identified bile reflux in more than half of the patients.

-Bile reflux mostly correlated with vomiting, heartburn, and regurgitation.

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Arnon-Sheleg, E., Farraj, M., Michael, S. et al. Modified Hepatobiliary Scintigraphy for the Diagnosis of Bile Reflux in One-Anastomosis Gastric Bypass Surgery: a Prospective Multicenter Study. OBES SURG 33, 1997–2004 (2023). https://doi.org/10.1007/s11695-023-06632-0

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  • DOI: https://doi.org/10.1007/s11695-023-06632-0

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