Skip to main content
SpringerLink
Log in

What to Expect in the Excluded Stomach Mucosa after Vertical Banded Roux-en-Y Gastric Bypass for Morbid Obesity

  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Mucosal alterations after vertical banded Roux-en-Y gastric bypass have not been clearly evaluated. The aim of this paper was to analyze the histological findings and the presence of Helicobacter pylori in the excluded stomach. Forty consecutive patients who underwent Roux-en-Y gastric bypass longer than 36 months were selected for double-balloon enteroscopy. The excluded stomach was reached in 35/40 patients (88%). Morphological alterations were analyzed through hematoxilin and eosin and the presence of H. pylori was confirmed with Giemsa staining. Thirty patients (86%) were female, and the mean age was 43 years old. The mean postoperative time was 78 months (36–110 months). Histologically, all patients had chronic gastritis in the bypassed stomach, with pangastritis in 33/35 (94%). Five cases (5/35, 14%) presented atrophy and four of them also had intestinal metaplasia. Helicobacter pylori was detected in 7/35 (20%) of the excluded stomach and in 12/35 (34%) of the functional pouch. All patients positive for H. pylori in the excluded stomach were also positive in the functional pouch, p = 0.0005. Helicobacter pylori is still present in the excluded stomach after Roux-en-Y gastric bypass and might be considered for treatment. Histological findings indicated high prevalence of atrophy and intestinal metaplasia in this selected population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. Weber M, Clavien PA. Bariatric surgery—a successful way to battle the weight crisis. Br J Surg 2006;93:259–260.

    Article  PubMed  CAS  Google Scholar 

  2. Consensus Development Conference Panel. NIH Conference. Gastrointestinal surgery for severe obesity. Ann Intern Med 1991; 115, 956–961.

    Google Scholar 

  3. Raijman I, Strother SV, Donegan WL. Gastric cancer after gastric bypass for obesity. Case report. J Clin Gastroenterol 1991;13(2):191–194.

    Article  PubMed  CAS  Google Scholar 

  4. Lord RV, Edwards PD, Coleman MJ. Gastric cancer in the bypassed segment after operation for morbid obesity. The Australian and New Zealand Journal of Surgery 1997;67(8):580–582.

    PubMed  CAS  Google Scholar 

  5. Voellinger DC, Inabnet WB. Laparoscopic Roux-en-Y gastric bypass with remnant gastrectomy for focal intestinal metaplasia of the gastric antrum. Obes Surg 2002;12(5):695–698.

    Article  PubMed  Google Scholar 

  6. Khitin L, Roses RE, Birkett DH. Cancer in the gastric remnant after gastric bypass: A case report. Curr Surg 2003;60(5):521–523.

    Article  PubMed  Google Scholar 

  7. Escalona A, Guzman S, Ibanez L, Meneses L, Huete A, Solar A. Gastric cancer after Roux-en-Y gastric bypass. Obes Surg 2005;15(3):423–427.

    PubMed  Google Scholar 

  8. Trincado MT, del Olmo JC, Garcia Castano J, Cuesta C, Blanco JI, Awad S, Carbajo MA. Gastric pouch carcinoma after gastric bypass for morbid obesity. Obes Surg 2005;15(8):1215–1217.

    Article  PubMed  Google Scholar 

  9. Sakai P, Kuga R, Safatle-Ribeiro AV, Faintuch J, Gama-Rodrigues JJ, Ishida RK, Furuya Jr CK, Yamamoto H, Ishioka S. Is it feasible to reach the bypassed stomach after Roux-en-Y gastric bypass for morbid obesity? The use of the double-balloon enteroscope. Endoscopy 2005;37:566–569.

    Article  PubMed  CAS  Google Scholar 

  10. Capella JF, Capella RF. An assessment of vertical banded gastroplasty-Roux-en-Y gastric bypass for the treatment of morbid obesity. Am J Surg 2002;183(2):117–123.

    Article  PubMed  Google Scholar 

  11. Csendes A, Burdiles P, Papapietro K, Diaz JC, Maluenda F, Burgos A, Rojas J. Results of gastric bypass plus resection of the distal excluded gastric segment in patients with morbid obesity. J Gastrointest Surg 2005;9(1):121–131.

    Article  PubMed  Google Scholar 

  12. Madan AK, Lanier BJ, Tichansky DS, Ternovits CA. Laparoscopic Roux-en-Y gastric bypass with subtotal gastrectomy. Obes Surg 2005;15(9):1332–1335.

    Article  PubMed  Google Scholar 

  13. Sundbom M, Nyman R, Hedenstrom H, Gustavsson S. Investigation of the excluded stomach after Roux-en-Y gastric bypass. Obes Surg 2001;11(1):25–27.

    Article  PubMed  CAS  Google Scholar 

  14. Braley SC, Nguyen NT, Wolfe BM. Late gastrointestinal hemorrhage after gastric bypass. Obes Surg 2002;12(3):404–407.

    Article  PubMed  Google Scholar 

  15. Silecchia G, Catalano C, Gentileschi P, Elmore U, Restuccia A, Gagner M, Basso N. Virtual gastroduodenoscopy: A new look at the bypassed stomach and duodenum after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2002;12(1):39–48.

    Article  PubMed  Google Scholar 

  16. Yamamoto H, Sekine Y, Sato Y, Higashizawa T, Miyata T, Iino S, Ido K, Sugano K. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001;53:216–220.

    Article  PubMed  CAS  Google Scholar 

  17. Yamamoto H, Kita H, Sunada K, Hayashi Y, Sato H, Yano T, Iwamoto M, Sekine Y, Miyata T, Kuno A, Ajibe H, Ido K, Sugano K. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol 2004;2:1010–1016.

    Article  PubMed  Google Scholar 

  18. Sundbom M, Hedenstrom H, Gustavsson S. Duodenogastric bile reflux after gastric bypass: A cholescintigraphic study. Dig Dis Sci 2002;47:1891–1896.

    Article  PubMed  CAS  Google Scholar 

  19. Safatle-Ribeiro AV, Ribeiro Jr. U, Reynolds JC. Gastric stump cancer: what is the risk? Dig Dis 1998;16:159–168.

    Article  PubMed  CAS  Google Scholar 

  20. Alam K, Schubert TT, Bologna SD, Ma CK. Increased density of Helicobacter pylori on antral biopsy is associated with severity of acute and chronic inflammation and likelihood of duodenal ulceration. Am J Gastroenterol 1992;87(4):424–428.

    PubMed  CAS  Google Scholar 

  21. Lynch DAF, Mapstone NP, Clarke AM T, Jackson P, Dixon MF, Quirke P, Axon ATR. Cell proliferation in the gastric corpus in Helicobacter pylori associated gastritis and after gastric resection. Gut 1995;36:351–353.

    PubMed  CAS  Google Scholar 

  22. Sobala GM, O’Connor HJ, Dewar EP, King RFG, Axon ATR, Dixon MF. Bile reflux and intestinal metaplasia in gastric mucosa. J Clin Pathol 1993;46:235–240.

    PubMed  CAS  Google Scholar 

  23. Safatle-Ribeiro AV, Ribeiro Jr. U, Clarke MR, Sakai P, Gama-Rodrigues JJ, Safatle NF, Garrido Jr. AB, Reynolds JC. Relationship between persistence of Helicobacter pylori and dysplasia, intestinal metaplasia, atrophy, inflammation, and cell proliferation following partial gastrectomy. Dig Dis Sci 1999;44:243–252.

    Article  PubMed  CAS  Google Scholar 

  24. Correa P. Human gastric carcinogenesis: a multistep and multifactorial process—first American Cancer Society award lecture on cancer epidemiology and prevention. Cancer Res 1992;52:6735–6740.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank Thaise Yumie Tomokani for her technical assistance.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, University of São Paulo School of Medicine, Rua Treze de maio, 1954, Cj. 54, São Paulo, 01327-002, Brazil

    Adriana Vaz Safatle-Ribeiro, Rogério Kuga, Kiyoshi Iriya, Ulysses Ribeiro Jr., Joel Faintuch, Robson K. Ishida, Carlos Eduardo P. Corbett, Arthur Belarmino Garrido Jr., Shinichi Ishioka & Paulo Sakai

Authors
  1. Adriana Vaz Safatle-Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rogério Kuga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kiyoshi Iriya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ulysses Ribeiro Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joel Faintuch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robson K. Ishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carlos Eduardo P. Corbett
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Arthur Belarmino Garrido Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shinichi Ishioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Paulo Sakai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adriana Vaz Safatle-Ribeiro.

Additional information

This work was supported by a grant from the Foundation of Support to the Research of the State of São Paulo (FAPESP).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Safatle-Ribeiro, A.V., Kuga, R., Iriya, K. et al. What to Expect in the Excluded Stomach Mucosa after Vertical Banded Roux-en-Y Gastric Bypass for Morbid Obesity. J Gastrointest Surg 11, 133–137 (2007). https://doi.org/10.1007/s11605-006-0047-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-006-0047-1

Keywords

Search

Navigation