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Si Y, Lin S, Guan W, Shen J, Liang H. Comparison of Sleeve Gastrectomy with Loop Duodenojejunal Bypass Versus One Anastomosis Gastric Bypass for Type 2 Diabetes: The Role of Pylorus Preservation. Obes Surg 2024; 34:2391-2398. [PMID: 38780835 DOI: 10.1007/s11695-024-07294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) is recognized as a standard procedure in metabolic surgery. However, concerns about postoperative bile reflux and nutritional risks are prevalent. Comparatively, sleeve gastrectomy with loop duodenojejunal bypass (SG + LoopDJB) bypasses an equivalent length of the foregut as OAGB while maintaining pyloric function. The role of pylorus function remains to be further elucidated regarding these metabolic procedures' therapeutic outcomes and side effects. METHOD A retrospective study was conducted in our center to compare the surgical safety and 1-year outcomes of OAGB and SG + LoopDJB regarding type 2 diabetes mellitus (T2DM) remission, weight loss, gastrointestinal disorders, and nutritional status in T2DM patients matched by gender, age, and BMI. RESULTS The baseline characteristics were comparable between groups. Compared with OAGB, SG + LoopDJB had longer operative time and length of stay (LOS) but similar major postoperative complications. At 1-year follow-up, OAGB has similar diabetes remission (both 91.9%), weight loss effect (28.1 ± 7.1% vs. 30.2 ± 7.0% for %TWL), and lipidemia improvement to SG + LoopDJB (P > 0.05). However, OAGB presented a higher incidence of hypoalbuminemia (11.9% vs. 2.4%, P = 0.026) but a low incidence of gastroesophageal reflux disease (GERD) symptoms (9.5% vs. 26.2%, P = 0.046) than SG + LoopDJB. There was no statistical difference regarding other gastrointestinal disorders and nutritional deficiencies between groups. CONCLUSION Both OAGB and SG + LoopDJB show comparable, favorable outcomes in weight loss, T2DM remission, and lipidemia improvement at the 1-year follow-up. Pylorus preservation, while increasing surgical difficulty and the risk of de novo GERD, may reduce the risk of postoperative hypoalbuminemia.
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Affiliation(s)
- Yiming Si
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Shibo Lin
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Wei Guan
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - JiaJia Shen
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Hui Liang
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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Brunaldi VO, Abboud DM, Abusaleh RR, Al Annan K, Razzak FA, Ravi K, Valls EJV, Storm AC, Ghanem OM, Abu Dayyeh BK. Post-bariatric Surgery Changes in Secondary Esophageal Motility and Distensibility Parameters. Obes Surg 2024; 34:347-354. [PMID: 38123782 DOI: 10.1007/s11695-023-06959-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Despite the increasing number of bariatric procedures over the recent years, the physiological changes in secondary esophageal motility and distensibility parameters after surgery remain unknown. METHODS This is a retrospective, single-center cohort study comparing esophageal planimetry and gastroesophageal junction (GEJ) distensibility in post-bariatric surgery patients (Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and conversion/revisional patients (DH)) and native-anatomy patients with obesity (NAC). Distensibility refers to the area achieved with a certain amount of pressure, and secondary peristalsis represents the esophageal response to an intended obstruction. Patients with pre-surgical dysmotility symptoms were excluded from the study. RESULTS From November 2018 to January 2023, 167 patients were evaluated and eligible for this study (RYGB = 87, SG = 33, NAC = 22, DH = 25). In NAC cohort, 17/22 (77%) patients presented normal motility patterns compared to 35/87 (40%) RYGB, 12/33 (36%) SG, and 5/25 (20%) DH (p < 0.05 for all comparisons). The most common abnormal motility pattern for all three bariatric cohorts was absent contractions. DH patients generally had the highest mean maximum distensibility index averages, followed by SG, RYGB, and NAC. CONCLUSION Bariatric surgery affects esophageal and GEJ physiology, and it is associated with higher rates of secondary dysmotility. DH patients have even higher rates of dysmotility. Further studies assessing clinical data and their correlation with manometric and pH-metric findings are needed.
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Affiliation(s)
- Vitor Ottoboni Brunaldi
- Gastroenterology and Hepatology Division, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Donna Maria Abboud
- Gastroenterology and Hepatology Division, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Rami R Abusaleh
- Gastroenterology and Hepatology Division, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Karim Al Annan
- Gastroenterology and Hepatology Division, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Farah Abdul Razzak
- Gastroenterology and Hepatology Division, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Karthik Ravi
- Gastroenterology and Hepatology Division, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Eric J Vargas Valls
- Gastroenterology and Hepatology Division, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Andrew C Storm
- Gastroenterology and Hepatology Division, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Barham K Abu Dayyeh
- Gastroenterology and Hepatology Division, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Tolone S, Conzo G, Flagiello L, Gambardella C, Lucido FS, Brusciano L, Parisi S, De Bortoli N, Savarino EV, Del Genio G, Docimo L. De Novo Gastroesophageal Reflux Disease Symptoms Are Infrequent after Sleeve Gastrectomy at 2-Year Follow-Up Using a Comprehensive Preoperative Esophageal Assessment. J Clin Med 2024; 13:545. [PMID: 38256679 PMCID: PMC10816106 DOI: 10.3390/jcm13020545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/12/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Pathological obesity is a growing public health concern, and its association with gastroesophageal reflux disease (GERD) poses challenges in selecting the appropriate bariatric procedure. Sleeve gastrectomy (SG) has become a popular choice due to its simplicity and effectiveness in weight loss. However, concerns regarding postoperative GERD have been raised. This study aimed to evaluate the association between preoperative assessment of esophageal function and the risk of developing postoperative GERD in patients undergoing SG. A comprehensive evaluation was conducted, including symptom assessment, upper endoscopy, high-resolution esophageal manometry (HRM), and 24 h esophageal pH impedance monitoring (MII-pH). A total of 500 obese patients were included, and their data were compared with 25 healthy volunteers. This study revealed that patients without GERD symptoms, normal endoscopy, HRM, and MII-pH were suitable candidates for SG, with low risk of developing postoperative GERD. The addition of fundoplication techniques to SG may be considered in patients with mild reflux or those at risk of developing it. This study emphasizes the importance of preoperative evaluation in selecting the appropriate bariatric procedure to minimize the risk of postoperative GERD and expand the indications for SG in obese patients.
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Affiliation(s)
- Salvatore Tolone
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy (L.F.); (L.B.); (S.P.); (G.D.G.); (L.D.)
| | - Giovanni Conzo
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy (L.F.); (L.B.); (S.P.); (G.D.G.); (L.D.)
| | - Luigi Flagiello
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy (L.F.); (L.B.); (S.P.); (G.D.G.); (L.D.)
| | - Claudio Gambardella
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy (L.F.); (L.B.); (S.P.); (G.D.G.); (L.D.)
| | - Francesco Saverio Lucido
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy (L.F.); (L.B.); (S.P.); (G.D.G.); (L.D.)
| | - Luigi Brusciano
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy (L.F.); (L.B.); (S.P.); (G.D.G.); (L.D.)
| | - Simona Parisi
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy (L.F.); (L.B.); (S.P.); (G.D.G.); (L.D.)
| | - Nicola De Bortoli
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56127 Pisa, Italy;
| | - Edoardo Vincenzo Savarino
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, 35128 Padua, Italy;
| | - Gianmattia Del Genio
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy (L.F.); (L.B.); (S.P.); (G.D.G.); (L.D.)
| | - Ludovico Docimo
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy (L.F.); (L.B.); (S.P.); (G.D.G.); (L.D.)
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Esparham A, Ahmadyar S, Zandbaf T, Dalili A, Rezapanah A, Rutledge R, Khorgami Z. Does One-Anastomosis Gastric Bypass Expose Patients to Gastroesophageal Reflux: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:4080-4102. [PMID: 37880462 DOI: 10.1007/s11695-023-06866-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Abstract
This systematic review and meta-analysis aimed to investigate the incidence of new-onset gastroesophageal reflux, reflux change, esophagitis, Barrett's esophagus, and revision due to reflux, gastritis, and marginal ulcer after one-anastomosis gastric bypass (OAGB). We performed subgroup analyses based on primary and revisional OAGB and time of follow-up. Meta-analysis of 87 studies with 27,775 patients showed a 6% rate of new-onset reflux after OAGB. Preoperative reflux status did not change significantly after OAGB. The rate of esophagitis and Barrett's esophagus was 15% and 1%, respectively. The new-onset reflux rate after OAGB was significantly higher than gastric bypass but not different with sleeve gastrectomy. The current study showed a relatively low rate of reflux and its complications after OAGB, but it was significantly higher than Roux-en-Y gastric bypass.
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Affiliation(s)
- Ali Esparham
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheil Ahmadyar
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tooraj Zandbaf
- Department of General Surgery, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
| | - Amin Dalili
- Department of General Surgery, School of Medicine, Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Rezapanah
- Department of General Surgery, School of Medicine, Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robert Rutledge
- Center for Laparoscopic Obesity Surgery, 6240 N Durango Dr STE 120, Las Vegas, NV, 89149, USA
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma School of Community Medicine, 1919 S. Wheeling Avenue, Suite 600, Tulsa, OK, 74104-5638, USA.
- Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Khalaj A, Barzin M, Ebadinejad A, Mahdavi M, Ebrahimi N, Valizadeh M, Hosseinpanah F. Revisional Bariatric Surgery due to Complications: Indications and Outcomes. Obes Surg 2023; 33:3463-3471. [PMID: 37770774 DOI: 10.1007/s11695-023-06832-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/06/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The increasing prevalence of bariatric procedures has led to a surge in revisional surgeries. Failure of bariatric surgery can be attributed to inadequate weight loss or complications necessitating revisional surgery. In this study, we investigated the indications and outcomes of revisional surgery due to complications following primary bariatric surgery. MATERIALS AND METHODS A retrospective study was conducted using data from the Tehran Obesity Treatment Study, which included patients who underwent revisional bariatric surgery between March 2013 and September 2021 due to complications following primary bariatric surgery. RESULTS Of the 5382 patients who underwent primary bariatric surgery (sleeve gastrectomy, one-anastomosis gastric bypass, and Roux-en-Y gastric bypass), 203 (3.70%) required revisional surgery, with 37 cases performed due to surgical complications. The indications of revisional operations were gastroesophageal reflux disease (GERD) (n=17, 45.9%), protein-calorie malnutrition (PCM) (n=14, 37.8%), unexplained abdominal pain (n=5, 13.5%), and phytobezoar (n=1, 0.03%). In the postoperative follow-up, most patients exhibited improvement in signs and symptoms related to underlying causes. However, eight patients experienced early or late complications of grade III or higher according to the Clavien-Dindo classification, with one death resulting from liver failure. CONCLUSION Revisional bariatric surgery may effectively address complications from primary bariatric surgery, with the majority of patients experiencing improvements in symptoms. While the overall incidence of revisional surgery due to complications is relatively low, our findings suggest that GERD and PCM are the most common indications for revisional surgery.
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Affiliation(s)
- Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran
| | - Amir Ebadinejad
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran.
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran
| | - Navid Ebrahimi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran.
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Parkitna J, Jaworski P, Binda A, Barski K, Tarnowski W. Effect of SASI procedure (Single Anastomosis Sleeve Ileal) on the symptoms of gastroesophageal reflux disease in bariatric patients - a review of the literature. POLISH JOURNAL OF SURGERY 2023; 96:60-64. [PMID: 38348987 DOI: 10.5604/01.3001.0053.3998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The problem of gastroesophageal reflux disease among bariatric patients is constantly growing. While bariatric surgery is the most effective method of treating obesity and related diseases, not all surgical procedures lead to improvement or resolution of gastroesophageal reflux disease. The search for the "ideal" surgical procedure for this group of patients is ongoing. The relatively recently introduced SASI procedure seems to have a beneficial effect on GERD symptoms and may be an alternative anti-reflux procedure in obese patients. The presented paper is a review of the latest literature on the impact of SASI procedure on the symptoms of gastroesophageal reflux disease.
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Affiliation(s)
- Joanna Parkitna
- Clinical Department of General, Oncological and Bariatric Surgery CMKP, Warsaw, Poland
| | - Paweł Jaworski
- Clinical Department of General, Oncological and Bariatric Surgery CMKP, Warsaw, Poland
| | - Artur Binda
- Clinical Department of General, Oncological and Bariatric Surgery CMKP, Warsaw, Poland
| | - Krzysztof Barski
- Clinical Department of General, Oncological and Bariatric Surgery CMKP, Warsaw, Poland
| | - Wiesław Tarnowski
- Clinical Department of General, Oncological and Bariatric Surgery CMKP, Warsaw, Poland
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Luna Aufroy A, Rebasa Cladera P, Montmany Vioque S. Barrett's esophagus and esophageal cancer after sleeve gastrectomy. Myth or reality? Cir Esp 2023; 101 Suppl 4:S39-S42. [PMID: 37979936 DOI: 10.1016/j.cireng.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/13/2023] [Indexed: 11/20/2023]
Abstract
Sleeve gastrectomy has become the most performed bariatric surgery technique in the world. This bariatric technique has been related to the appearance of gastroesophageal reflux and recently with de novo Barrett's esophagus. It is not clear that this leads to an increased incidence of esophageal adenocarcinoma. In this review we analyze the current scientific literature to try to answer the true incidence of Barrett's esophagus and adenocarcinoma after sleeve gastrectomy, and whether these data should make us change the indications for this technique.
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Affiliation(s)
- Alexis Luna Aufroy
- Servicio de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain.
| | - Pere Rebasa Cladera
- Servicio de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - Sandra Montmany Vioque
- Servicio de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
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Coupaye M, Gorbatchef C, Dior M, Pacheco A, Duboc H, Calabrese D, Moszkowicz D, Le Gall M, Chen R, Soliman H, Ledoux S. Endoscopic Follow-Up Between 3 and 7 Years After Sleeve Gastrectomy Reveals Antral Reactive Gastropathy but no Barrett's Esophagus. Obes Surg 2023; 33:3112-3119. [PMID: 37605066 DOI: 10.1007/s11695-023-06785-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The main concerns following sleeve gastrectomy (SG) include the risk of gastroesophageal reflux disease (GERD) and its complications, such as Barrett's esophagus (BE). However, there is conflicting data on esophageal conditions, and studies on alterations of gastric mucosa after SG are lacking, despite reported cases of gastric cancer. Our aim was to assess esophageal and gastric lesions after SG. METHODS From November 2017, an upper gastrointestinal endoscopy (UGE) was proposed at least 3 years after SG to all patients operated on in our institution. Endoscopic results and gastric histological findings were analyzed. BE was defined as endoscopically suspected esophageal metaplasia with histological intestinal metaplasia. RESULTS Between September 2008 and August 2018, 375 patients underwent SG at our institution, of which 162 (43%) underwent at least one UGE 3 years or more after SG (91% women, mean preoperative age: 43.3±10.3 years). Despite a significant increase in the prevalence of symptomatic GERD, hiatal hernia, and esophagitis after SG (p<0.001 vs. preoperatively), no cases of BE were detected. Gastric dysplasia was not found and the prevalence of gastric atrophy tended to decrease after SG. However, 27% of patients with gastric biopsies developed antral reactive gastropathy. CONCLUSIONS At a mean follow-up of 54 months after SG, no BE or gastric dysplasia was identified. However, reactive gastric lesions appeared, and their long-term consequences need to be further clarified. Thus, the timing of endoscopic follow-up, starting as early as 3 years after SG should be reevaluated to improve patient adherence with long-term endoscopies.
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Affiliation(s)
- Muriel Coupaye
- Université Paris Cité, Centre de Recherche sur l'Inflammation, Inserm UMRS 1149, 75018, Paris, France.
- Assistance Publique-Hôpitaux de Paris, Service des Explorations Fonctionnelles, Centre Intégré Nord Francilien de prise en charge de l'Obésité (CINFO), Hôpital Louis-Mourier, 92700, Colombes, France.
| | - Caroline Gorbatchef
- Assistance Publique-Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Louis-Mourier, 92700, Colombes, France
| | - Marie Dior
- Assistance Publique-Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Louis-Mourier, 92700, Colombes, France
| | - Aude Pacheco
- Assistance Publique-Hôpitaux de Paris, Service des Explorations Fonctionnelles, Centre Intégré Nord Francilien de prise en charge de l'Obésité (CINFO), Hôpital Louis-Mourier, 92700, Colombes, France
| | - Henri Duboc
- Université Paris Cité, Centre de Recherche sur l'Inflammation, Inserm UMRS 1149, 75018, Paris, France
- Assistance Publique-Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Louis-Mourier, 92700, Colombes, France
| | - Daniela Calabrese
- Université Paris Cité, Centre de Recherche sur l'Inflammation, Inserm UMRS 1149, 75018, Paris, France
- Assistance Publique-Hôpitaux de Paris, Service de Chirurgie Digestive, Centre Intégré Nord Francilien de prise en charge de l'Obésité (CINFO), Hôpital Bichat-Claude-Bernard, 75018, Paris, France
| | - David Moszkowicz
- Université Paris Cité, Centre de Recherche sur l'Inflammation, Inserm UMRS 1149, 75018, Paris, France
- Assistance Publique-Hôpitaux de Paris, Service de Chirurgie Digestive, Centre Intégré Nord Francilien de prise en charge de l'Obésité (CINFO), Hôpital Louis-Mourier, 92700, Colombes, France
| | - Maude Le Gall
- Université Paris Cité, Centre de Recherche sur l'Inflammation, Inserm UMRS 1149, 75018, Paris, France
| | - Ruiqian Chen
- Assistance Publique-Hôpitaux de Paris, Service d'Anatomo-Pathologie, Hôpital Bichat-Claude-Bernard, 75018, Paris, France
| | - Heithem Soliman
- Université Paris Cité, Centre de Recherche sur l'Inflammation, Inserm UMRS 1149, 75018, Paris, France
- Assistance Publique-Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Louis-Mourier, 92700, Colombes, France
| | - Séverine Ledoux
- Université Paris Cité, Centre de Recherche sur l'Inflammation, Inserm UMRS 1149, 75018, Paris, France
- Assistance Publique-Hôpitaux de Paris, Service des Explorations Fonctionnelles, Centre Intégré Nord Francilien de prise en charge de l'Obésité (CINFO), Hôpital Louis-Mourier, 92700, Colombes, France
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Castagneto-Gissey L, Gualtieri L, Diddoro A, Genco A, Casella G. Conversion from Sleeve Gastrectomy to Roux-en-Y Gastric Bypass for Refractory GERD and Barrett's Esophagus. J Gastrointest Surg 2023; 27:1713-1715. [PMID: 37069458 DOI: 10.1007/s11605-023-05678-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/01/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Lidia Castagneto-Gissey
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
| | - Loredana Gualtieri
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Annalisa Diddoro
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Alfredo Genco
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Giovanni Casella
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
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10
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Ghanem OM, Ghazi R, Abdul Razzak F, Bazerbachi F, Ravi K, Khaitan L, Kothari SN, Abu Dayyeh BK. Turnkey algorithmic approach for the evaluation of gastroesophageal reflux disease after bariatric surgery. Gastroenterol Rep (Oxf) 2023; 11:goad028. [PMID: 37304555 PMCID: PMC10256627 DOI: 10.1093/gastro/goad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/12/2022] [Accepted: 02/01/2023] [Indexed: 06/13/2023] Open
Abstract
Bariatric surgeries are often complicated by de-novo gastroesophageal reflux disease (GERD) or worsening of pre-existing GERD. The growing rates of obesity and bariatric surgeries worldwide are paralleled by an increase in the number of patients requiring post-surgical GERD evaluation. However, there is currently no standardized approach for the assessment of GERD in these patients. In this review, we delineate the relationship between GERD and the most common bariatric surgeries: sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), with a focus on pathophysiology, objective assessment, and underlying anatomical and motility disturbances. We suggest a stepwise algorithm to help diagnose GERD after SG and RYGB, determine the underlying cause, and guide the management and treatment.
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Affiliation(s)
- Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rabih Ghazi
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, MN, USA
| | - Karthik Ravi
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Leena Khaitan
- Department of Surgery, Case Western Reserve University, Cleveland, OH, USA
| | | | - Barham K Abu Dayyeh
- Corresponding author. Division of Gastroenterology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel: +1-507-284-2511; Fax: +1-507-284-0538;
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11
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Verrastro O, Panunzi S, Castagneto-Gissey L, De Gaetano A, Lembo E, Capristo E, Guidone C, Angelini G, Pennestrì F, Sessa L, Vecchio FM, Riccardi L, Zocco MA, Boskoski I, Casella-Mariolo JR, Marini P, Pompili M, Casella G, Fiori E, Rubino F, Bornstein SR, Raffaelli M, Mingrone G. Bariatric-metabolic surgery versus lifestyle intervention plus best medical care in non-alcoholic steatohepatitis (BRAVES): a multicentre, open-label, randomised trial. Lancet 2023; 401:1786-1797. [PMID: 37088093 DOI: 10.1016/s0140-6736(23)00634-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Observational studies suggest that bariatric-metabolic surgery might greatly improve non-alcoholic steatohepatitis (NASH). However, the efficacy of surgery on NASH has not yet been compared with the effects of lifestyle interventions and medical therapy in a randomised trial. METHODS We did a multicentre, open-label, randomised trial at three major hospitals in Rome, Italy. We included participants aged 25-70 years with obesity (BMI 30-55 kg/m2), with or without type 2 diabetes, with histologically confirmed NASH. We randomly assigned (1:1:1) participants to lifestyle modification plus best medical care, Roux-en-Y gastric bypass, or sleeve gastrectomy. The primary endpoint of the study was histological resolution of NASH without worsening of fibrosis at 1-year follow-up. This study is registered at ClinicalTrials.gov, NCT03524365. FINDINGS Between April 15, 2019, and June 21, 2021, we biopsy screened 431 participants; of these, 103 (24%) did not have histological NASH and 40 (9%) declined to participate. We randomly assigned 288 (67%) participants with biopsy-proven NASH to lifestyle modification plus best medical care (n=96 [33%]), Roux-en-Y gastric bypass (n=96 [33%]), or sleeve gastrectomy (n=96 [33%]). In the intention-to-treat analysis, the percentage of participants who met the primary endpoint was significantly higher in the Roux-en-Y gastric bypass group (54 [56%]) and sleeve gastrectomy group (55 [57%]) compared with lifestyle modification (15 [16%]; p<0·0001). The calculated probability of NASH resolution was 3·60 times greater (95% CI 2·19-5·92; p<0·0001) in the Roux-en-Y gastric bypass group and 3·67 times greater (2·23-6·02; p<0·0001) in the sleeve gastrectomy group compared with in the lifestyle modification group. In the per protocol analysis (236 [82%] participants who completed the trial), the primary endpoint was met in 54 (70%) of 77 participants in the Roux-en-Y gastric bypass group and 55 (70%) of 79 participants in the sleeve gastrectomy group, compared with 15 (19%) of 80 in the lifestyle modification group (p<0·0001). No deaths or life-threatening complications were reported in this study. Severe adverse events occurred in ten (6%) participants who had bariatric-metabolic surgery, but these participants did not require re-operations and severe adverse events were resolved with medical or endoscopic management. INTERPRETATION Bariatric-metabolic surgery is more effective than lifestyle interventions and optimised medical therapy in the treatment of NASH. FUNDING Fondazione Policlinico Universitario A Gemelli, Policlinico Universitario Umberto I and S Camillo Hospital, Rome, Italy.
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Affiliation(s)
| | - Simona Panunzi
- CNR-IASI, Laboratorio di Biomatematica, Consiglio Nazionale delle Ricerche, Istituto di Analisi dei Sistemi ed Informatica, Rome, Italy
| | | | - Andrea De Gaetano
- CNR-IASI, Laboratorio di Biomatematica, Consiglio Nazionale delle Ricerche, Istituto di Analisi dei Sistemi ed Informatica, Rome, Italy
| | | | - Esmeralda Capristo
- Università Cattolica del Sacro Cuore, Rome, Italy; Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Caterina Guidone
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Francesco Pennestrì
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Luca Sessa
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Fabio Maria Vecchio
- Department of Pathology and Laboratory Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Laura Riccardi
- Università Cattolica del Sacro Cuore, Rome, Italy; Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Maria Assunta Zocco
- Università Cattolica del Sacro Cuore, Rome, Italy; Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Ivo Boskoski
- Università Cattolica del Sacro Cuore, Rome, Italy; Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Pierluigi Marini
- Department of Endocrine and Bariatric-Metabolic Surgery, San Camillo Hospital, Rome, Italy
| | - Maurizio Pompili
- Università Cattolica del Sacro Cuore, Rome, Italy; Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Giovanni Casella
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Enrico Fiori
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Rubino
- Bariatric and Bariatric-Metabolic Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College Hospital, London UK
| | - Stefan R Bornstein
- Division of Diabetes & Nutritional Sciences, School of Cardiovascular and Metabolic Medicine & Sciences, King's College Hospital, London UK; Department of Medicine III, Universitätsklinikum Carl Gustav Carus an de Technischen Universität Dresden, Dresden, Germany
| | - Marco Raffaelli
- Università Cattolica del Sacro Cuore, Rome, Italy; Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Geltrude Mingrone
- Università Cattolica del Sacro Cuore, Rome, Italy; Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Division of Diabetes & Nutritional Sciences, School of Cardiovascular and Metabolic Medicine & Sciences, King's College Hospital, London UK.
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12
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Castagneto-Gissey L, Russo MF, D'Andrea V, Genco A, Casella G. Efficacy of Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair versus Sleeve-Fundoplication on Gastroesophageal Reflux Disease Resolution: Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12093323. [PMID: 37176762 PMCID: PMC10179224 DOI: 10.3390/jcm12093323] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/13/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: There is still disagreement over how sleeve gastrectomy (SG) affects gastroesophageal reflux disease (GERD). The debate regarding the best option for patients undergoing bariatric surgery who are also affected by GERD and/or hiatal hernia continues to divide the community of bariatric surgeons. While concomitant hiatal hernia repair (SG + HHR) has been proposed as a means of reducing the risk of GERD following SG with varying degrees of success, the addition of a fundoplication (SG + FP) has been suggested in recent years as a way to improve the lower esophageal sphincter's competency. The aim of this study is to systematically review and meta-analyze the efficacy of SG + HHR versus SG + FP on GERD remission in patients with obesity. (2) Methods: A systematic review of the literature was conducted, and studies analyzing the effects of SG + HHR versus SG + FP on postoperative GERD were included. The methodological quality of included trials was evaluated. The primary outcome was postoperative GERD rate, erosive esophagitis, and 12-month weight loss. Secondary outcomes included postoperative complications and mortality. The PRISMA guidelines were used to carry out the present systematic review (PROSPERO Registration Number: CRD42023405600). (3) Results: Fifteen articles with a total of 1164 patients were included in the meta-analysis; 554 patients underwent SG + HHR while 610 underwent SG + FP. In the SG + HHR group, 58.5 ± 28.9% of subjects presented clinical GERD symptoms compared to 20.4 ± 17.5% postoperatively (p < 0.001). In the SG + FP group, 64.8 ± 39.4% were affected by GERD preoperatively compared to only 5 ± 8.1% postoperatively (p < 0.001). SG + FP patients had a significantly greater GERD remission compared to SG + HHR (p < 0.001). Weight loss was similar between groups (p = 0.125). The rate of leaks was 0.18% and 0.33% in the SG + HHR and SG + FP, respectively (p = 0.657), while perforations were significantly higher after SG + FP compared to the SG + HHR group (3.1% versus 0%, p = 0.002). The mortality rate was significantly greater in the SG + FP group (0.5% versus 0%, p = 0.002). (4) Conclusions: This study revealed that both SG with concomitant HHR and sleeve-fundoplication are effective in terms of reflux resolution and weight outcomes, with superiority of SG + FP in terms of GERD control, despite a greater overall complication rate. Both strategies can therefore be suggested as a suitable alternative variant to a conventional SG in subjects with obesity and concomitant hiatal hernia and/or GERD. Studies with extended follow-up and direct comparisons of these surgical approaches to conventional SG are warranted.
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Affiliation(s)
- Lidia Castagneto-Gissey
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Maria Francesca Russo
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Vito D'Andrea
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Alfredo Genco
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Giovanni Casella
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
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13
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Orlow R, Herbella FAM, Katayama RC, Patti MG. Insights into the Paradox of the Weak Association Between Sleeve Gastrectomy and Barrett's Esophagus. Obes Surg 2023:10.1007/s11695-023-06599-y. [PMID: 37059866 DOI: 10.1007/s11695-023-06599-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023]
Abstract
Sleeve gastrectomy (SG) is deemed a refluxogenic operation but with a low incidence of postoperative Barrett´s esophagus (BE). We aimed to shed some light on the potential paradox of the weak association between SG, BE and esophageal adenocarcinoma (EAC). The high incidence of GERD after SG is not followed by an increased rate of BE and EAC, as these rates are similar to the general population. We hypothesized that this paradox may occur due to a difference in the gastro-esophageal reflux composition secondary to a lower content of bile, to a decrease in inflammation due to weight loss and hormonal changes, and to acquisition of healthier habits such as exercise, smoking cessation, and better eating behavior.
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Affiliation(s)
- Rafaella Orlow
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP, 04037-003, Brazil
| | - Fernando A M Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP, 04037-003, Brazil.
| | - Rafael C Katayama
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP, 04037-003, Brazil
| | - Marco G Patti
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
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14
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Gentileschi P, Sensi B, Siragusa L, Sorge R, Rispoli E, Angrisani L, Galfrascoli E, Bianciardi E, Giusti MP, De Luca M, Zappa MA, Balani A, Bellini R, Benavoli D, Berardi G, Casella G, Basso N, Cerbone MR, Di Lorenzo N, Facchiano E, Foletto M, Forestieri P, Foschi D, Grandone I, Lucchese M, Manno E, Musella M, Navarra G, Olmi S, Piazza L, PIlone V, Raffaelli M, Sarro G, Zaccaroni A. Evolution of Bariatric Surgery in Italy in the Last 11 Years: Data from the SICOB Yearly National Survey. Obes Surg 2023; 33:930-937. [PMID: 36690866 PMCID: PMC9871429 DOI: 10.1007/s11695-022-06435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Bariatric surgery (BS) is a relatively novel surgical field and is in continuous expansion and evolution. PURPOSE Aim of this study was to report changes in Italian surgical practice in the last decade. METHODS The Società Italiana di Chirurgia dell'Obesità (SICOB) conducted annual surveys to cense activity of SICOB centers between 2011 and 2021. Primary outcome was to detect differences in frequency of performance of adjustable gastric banding (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), bilio-pancreatic diversion (BPD), and gastric plication (GP). Secondary outcome was to detect differences in performance of main non-malabsorptive procedures (AGB + SG) and overall bypass procedures (RYGB + OAGB). Geographical differences were also investigated. RESULTS Median response rate was 92%. AGB declined from 36% of procedures in 2011 to 5% in 2021 (p < 0.0001). SG increased from 30% in 2011 to 55% in 2021 (p < 0.0001). RYGB declined from 25 to 12% of procedures (p < 0.0001). OAGB rose from 0% of procedures in 2011 to 15% in 2021 (p < 0.0001). BPD underwent decrease from 6.2 to 0.2% in 2011 and 2021, respectively (p < 0.0001). Main non-malabsorptive procedures significantly decreased while overall bypass procedures remained stable. There were significant differences among regions in performance of SG, RYGB, and OAGB. CONCLUSIONS BS in Italy evolved significantly during the past 10 years. AGB underwent a decline, as did BPD and GP which are disappearing and RYGB which is giving way to OAGB. The latter is rising and is the second most-performed procedure after SG which has been confirmed as the preferred procedure by Italian bariatric surgeons.
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Affiliation(s)
- Paolo Gentileschi
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy.,Bariatric and Metabolic Surgery Unit, San Carlo Di Nancy Hospital, Rome, Italy
| | - Bruno Sensi
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Leandro Siragusa
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Sorge
- Department of Biostatistics, Policlinico Tor Vergata University, Rome, Italy
| | | | - Luigi Angrisani
- Public Health Department "Federico II" University of Naples, Naples, Italy
| | - Elisa Galfrascoli
- Department of General Surgery, Fatebenefratelli Hospital, Milan, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, Psychiatric Chair, University of Rome Tor Vergata, 00133, Rome, Italy
| | | | - Maurizio De Luca
- Chief Department of General and Metabolic Surgery, Rovigo Hospital, Rovigo, Italy
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15
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Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus. Surg Endosc 2023; 37:1617-1628. [PMID: 36693918 DOI: 10.1007/s00464-023-09879-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/08/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. METHODS Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. RESULTS Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redo-procedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. CONCLUSION Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.
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16
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Castagneto-Gissey L, Gualtieri L, Diddoro A, Lauro A, Genco A, Casella G. Y Not Roux-en-Y?: Resolution of Barrett's Esophagus After Surgical Conversion of Gastric Sleeve in Two Patients. Dig Dis Sci 2023; 68:1698-1704. [PMID: 36853549 DOI: 10.1007/s10620-023-07874-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 03/01/2023]
Abstract
Esophageal lesions ranging from erosive esophagitis to Barrett's esophagus (BE) eventually develop months-years after sleeve gastrectomy (SG), representing a significant post-surgical issue in GI practice. Roux-en-Y gastric bypass (RYGB) conversion is a widespread and effective method of managing reflux and esophageal complications following SG. Although some studies using a limited sample size have demonstrated that RYGB performed as a primary procedure may regress BE presumably by reducing reflux, whether the same may apply to RYGB performed as revision surgery after SG has scarcely been addressed in the literature. Though histological regression of BE following primary RYGB occurs in 51.9% of patients, with regression of Barrett's dysplasia in 50% of cases, revisional RYGB yields a remission rate as high as 81.8% for Barrett's metaplasia and 100% for dysplastic lesions, although the number of subjects in the published studies are very small. We report two patients who developed GERD and BE following SG with complete regression 12 months after conversion to RYGB in both subjects, confirming the substantially greater proportion of BE resolution in patients undergoing RYGB as revision surgery following SG.
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Affiliation(s)
- Lidia Castagneto-Gissey
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Loredana Gualtieri
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Annalisa Diddoro
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Augusto Lauro
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Alfredo Genco
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Giovanni Casella
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
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17
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Perioperative Interventions to Prevent Gastroesophageal Reflux Disease and Marginal Ulcers After Bariatric Surgery - an International Experts' Survey. Obes Surg 2023; 33:1449-1462. [PMID: 36781593 DOI: 10.1007/s11695-023-06481-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/30/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE This study aimed to survey international experts in metabolic and bariatric surgery (MBS) to improve and consolidate perioperative interventions to prevent gastroesophageal reflux disease (GERD) and marginal ulcers (MU) after MBS. BACKGROUND Very important long-term complications after MBS include GERD, Barrett's esophagus, and MU. Prevention might be fundamental to reduce the incidence, severe complications, and the increasing number of revisional bariatric surgeries. METHODS An international scientific team designed an online confidential questionnaire with 45 multiple-choice questions. The survey was sent to 110 invited experts and 96 of them (from 41 different countries) participated from 21 July 2022 to 4 September 2022. RESULTS Most experts (≥ 90%) prescribe postoperative acid suppression agents after MBS. Life-long proton pump inhibitors prophylaxis in smokers with avoidance of non-steroidal anti-inflammatory drugs are recommended by most of the experts (66%, 73%) after any type of gastric bypass. Two-thirds of experts (69%) perform Helicobacter pylori eradication prior to MBS. Two-thirds of experts (68%) routinely perform EGD and biopsy before MBS. Follow-up esophagogastroduodenoscopy (EGD) and timing threshold for revisional and conversional MBS were variable among experts. CONCLUSION This expert survey underlines important perioperative interventions that reached a two-thirds consensus among MBS international experts. Variability in follow-up EGD, approach to complication management, and thresholds for revisional and conversional MBS emphasize the need for further researches and consensus guidelines.
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18
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Noel P, Nedelcu M, Olmi S, Gentileschi P, Caiazzo R, Pintado DGM, Garza MG, Roberto R, Abualsel A, Marchesini C, Boza C, Ungson G, Alarcon V, Carandina S, Zundel N, Ponce J, Lutfi RE. Evolving Technique of Laparoscopic Vertical Gastric Clip Placement. Obes Surg 2023; 33:1012-1016. [PMID: 36754925 DOI: 10.1007/s11695-023-06492-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Laparoscopic BariClip gastroplasty (LBCG) will address a similar tubular restriction than the one achieved with the laparoscopic sleeve gastrectomy (LSG) at the level of the gastric fundus, while maintaining the advantage of simplicity and anatomic preservation. The purpose of the current study was to analyze the risk of slippage and to present the evolving technique by adding gastro-gastric plication of the gastric wall covering the BariClip at those areas where the gastric wall "slips" between the limbs of the clip. METHODS All patients undergoing LBCG with the evolving technique of gastric plication around the device associated with antral gastroplasty from January 2021 to May 2022 were included in the study group (group A). A control group (group B) was designed with patients who underwent previous LBCG technique between May 2017 and June 2019. This is a case-controlled group with patients matched by gender and BMI. We have analyzed the postoperative complications and more notably the slippage. RESULTS One hundred seventy-six patients (44 male and 132 female) with a mean age of 33 years (± 11) underwent evolving technique of LBCG. A control group of 67 patients who underwent previous technique of LBCG was included. All procedures were completed by laparoscopy with no intraoperative complication. For the study group, we have recorded a number of 5 slippages (2.8%). The diagnosis occurred during the first 6 months after the operation. The management consisted of repositioning-3 cases-and BariClip removal-2 cases. For the control group, we have recorded a number of 3 slippages (4.3%). All three patients underwent BariClip removal, with no repositioning. CONCLUSIONS We reported a new technique of placement of the BariClip with additional gastric plication anterior, posterior, and volume reduction in the antrum to potentially reduce the rate of slippage and improve weight loss outcomes.
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Affiliation(s)
- Patrick Noel
- Emirates Specialty Hospital, Dubai, UAE.
- ELSAN, Clinique Bouchard, Clinique Bouchard, 77 Rue de Dr. Escat, 13006, Marseille, France.
| | - Marius Nedelcu
- ELSAN, Clinique Bouchard, Clinique Bouchard, 77 Rue de Dr. Escat, 13006, Marseille, France
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
| | - Stefano Olmi
- Policlinico San Marco Zingonia, Vita E Salute San Raffaele University Milan, Milan, Italy
| | - Paolo Gentileschi
- San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Robert Caiazzo
- Endocrine and General Surgery Department, Lille University Hospital, Lille, France
| | | | | | | | | | | | | | | | | | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
| | - Natan Zundel
- University at Buffalo, Buffalo, NY, USA
- Jackson North Medical Center, Miami, USA
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Felsenreich DM, Zach ML, Vock N, Jedamzik J, Eichelter J, Mairinger M, Gensthaler L, Nixdorf L, Richwien P, Bichler C, Kristo I, Langer FB, Prager G. Esophageal function and non-acid reflux evaluated by impedance-24 h-pH-metry, high-resolution manometry, and gastroscopy after one-anastomosis gastric bypass-outcomes of a prospective mid-term study. Surg Endosc 2023; 37:3832-3841. [PMID: 36693919 PMCID: PMC10156623 DOI: 10.1007/s00464-022-09857-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/27/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND One-Anastomosis Gastric Bypass (OAGB) is the third most common bariatric operation for patients with obesity worldwide. One concern about OAGB is the presence of acid and non-acid reflux in a mid- and long-term follow-up. The aim of this study was to objectively evaluate reflux and esophagus motility by comparing preoperative and postoperative mid-term outcomes. SETTING Cross-sectional study; University-hospital based. METHODS This study includes primary OAGB patients (preoperative gastroscopy, high-resolution manometry (HRM), and impedance-24 h-pH-metry) operated at Medical University of Vienna before 31st December 2017. After a mean follow-up of 5.1 ± 2.3 years, these examinations were repeated. In addition, history of weight, remission of associated medical problems (AMP), and quality of life (QOL) were evaluated. RESULTS A total of 21 patients were included in this study and went through all examinations. Preoperative weight was 124.4 ± 17.3 kg with a BMI of 44.7 ± 5.6 kg/m2, total weight loss after 5.1 ± 2.3 years was 34.4 ± 8.3%. In addition, remission of AMP and QOL outcomes were very satisfactory in this study. In gastroscopy, anastomositis, esophagitis, Barrett´s esophagus, and bile in the pouch were found in: 38.1%, 28.3%, 9.5%, and 42.9%. Results of HRM of the lower esophageal sphincter pressure were 28.0 ± 15.6 mmHg, which are unchanged compared to preoperative values. Nevertheless, in the impedance-24 h-pH-metry, acid exposure time and DeMeester score decreased significantly to 1.2 ± 1.2% (p = 0.004) and 7.5 ± 8.9 (p = 0.017). Further, the total number of refluxes were equal to preoperative; however, the decreased acid refluxes were replaced by non-acid refluxes. CONCLUSION This study has shown decreased rates of acid reflux and increased non-acid reflux after a mid-term outcome of primary OAGB patients. Gastroscopy showed signs of chronic irritation of the gastrojejunostomy, pouch, and distal esophagus, even in asymptomatic patients. Follow-up gastroscopies in OAGB patients after 5 years may be considered.
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Affiliation(s)
- D M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - M L Zach
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - N Vock
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - J Jedamzik
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - J Eichelter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - M Mairinger
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - L Gensthaler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - L Nixdorf
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - P Richwien
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - C Bichler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - I Kristo
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - F B Langer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - G Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
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20
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Safety and Efficacy of Laparoscopic Vertical Clip Gastroplasty: Early Results of an Italian Multicenter Study. Obes Surg 2023; 33:303-312. [PMID: 36459357 DOI: 10.1007/s11695-022-06364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/28/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Sleeve gastrectomy, the most commonly performed bariatric surgery procedure, carries limitations both short term including postoperative complications such as hemorrhage and gastric fistula and long term such as weight regain and gastroesophageal reflux. A new procedure has been proposed to overcome many of these limitations: laparoscopic vertical clip gastroplasty (LVCG) with BariClip. MATERIALS AND METHODS Fifty patients were offered LVCG and enrolled for a feasibility study in two referral bariatric centers. Indication was given as for sleeve gastrectomy, after a multidisciplinary path evaluating age, gender, BMI, comorbidities, eating behaviors, and gastroesophageal reflux. The primary outcome was major postoperative complications. Secondary outcomes included weight loss, incidence of de-novo GERD, and comorbidity resolution. RESULTS Patients had a mean age of 44 years and mean BMI of 37 kg/m2 ± 6.2. All procedures were performed successfully in laparoscopy, with no conversion or intraoperative adverse events. The overall major postoperative complication rate was 6%. Re-operation was required in three patients for slippage. No mortality occurred. Excess weight loss, excess BMI loss, and total weight loss at 6 months were 36%, 57%, and 22%, respectively. There was no instance of de-novo GERD. Resolution of hypertension occurred in 50% of cases, OSAS in 65% of cases, and DMII in 80% of cases. CONCLUSION The safety of LVCG procedure has been reproduced in a multicentric, multi-surgeon study. Weight loss outcomes appear promising. A randomized trial is needed to fully assess the benefits of LVCG.
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21
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Lee RXN, Rizkallah N, Chiappetta S, Stier C, Pouwels S, Sakran N, Singhal R, Mahawar K, Madhok B. Surgical Management of Gastro-oesophageal Reflux Disease After One Anastomosis Gastric Bypass - a Systematic Review. Obes Surg 2022; 32:4057-4065. [PMID: 36255646 DOI: 10.1007/s11695-022-06301-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 10/24/2022]
Abstract
Gastro-oesophageal reflux disease (GORD) after one anastomosis gastric bypass (OAGB) remains a concern. We reviewed the current literature on revisional surgery after OAGB for GORD. MEDLINE, EMBASE, and PubMed databases were searched. We identified 21 studies, appraising 13,658 OAGB patients. A total of 230 (1.6%) patients underwent revisional surgery for GORD. Revision to Roux-en-Y configuration was performed in 211 (91.7%) patients. Six (2.6%) patients had a Braun entero-enterostomy added to the OAGB. Thirteen (5.6%) patients underwent excluded stomach fundoplication (ESF). Reflux symptoms resolved in 112 (48.6%) patients, persisted in 13 (5.6%) patients, and were not reported in 105 (45.6%) patients. Revisional surgery after OAGB for GORD appears to be rare, and when required, conversion to Roux-en-Y configuration is the commonest choice.
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Affiliation(s)
- Rachel Xue Ning Lee
- East Midlands Bariatric and Metabolic Institute, University Hospital of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Nayer Rizkallah
- East Midlands Bariatric and Metabolic Institute, University Hospital of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Sonja Chiappetta
- Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Christine Stier
- Department of Surgical Endoscopy, Sana Hospitals, Germany and Obesity Center NRW, Huerth, Germany
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Nasser Sakran
- Department of Surgery, Holy Family Hospital, Nazareth, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Rishi Singhal
- Bariatric and Upper GI Unit, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kamal Mahawar
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK.,Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Brijesh Madhok
- East Midlands Bariatric and Metabolic Institute, University Hospital of Derby and Burton NHS Foundation Trust, Derby, UK.
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22
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Genco A, Castagneto-Gissey L, Casella G. Comment on: Alarmists at the Gates: Esophageal Adenocarcinoma After Sleeve Gastrectomy Is Not Different than with Other Bariatric/Metabolic Surgeries. Obes Surg 2022; 32:3463-3465. [PMID: 35963914 DOI: 10.1007/s11695-022-06241-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Alfredo Genco
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Lidia Castagneto-Gissey
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
| | - Giovanni Casella
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
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23
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The utility of endoscopy prior to bariatric surgery: an 11-year retrospective analysis of 885 patients. Surg Endosc 2022; 37:3127-3135. [PMID: 35941309 DOI: 10.1007/s00464-022-09485-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/13/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Our aim was to evaluate the diagnostic yield of routine preoperative esophagogastroduodenoscopy (p-EGD) in patients undergoing bariatric surgery. Many medical problems that are common in patients with obesity, including gastroesophageal reflux disease (GERD) and hiatal hernias, have important implications for patients undergoing bariatric surgery. While p-EGD is considered standard of care prior to antireflux surgery, the role of p-EGD in bariatric surgery patients remains controversial. METHODS AND PROCEDURES We performed a retrospective chart review of 885 patients who underwent primary bariatric surgery at a university hospital-based bariatric surgery program between March 2011 and February 2022. Clinical history, demographics, and preoperative EGD reports were reviewed for abnormal findings. RESULTS Of the 885 patients evaluated in this study, one or more abnormal EGD findings were observed in 83.2% of patients. More than half of our patients (54.7%) presented with history of heartburn, reflux, or GERD. EGD findings demonstrated a hernia in 43.1% of patients [(Type I: 40.6%; Type II: 0.5%; Type III: 2.1%)]. 68.0% of patients were biopsied. Among patients who were biopsied, other findings included gastritis (32.4%), esophagitis (8.0%), eosinophilic esophagitis (4.7%), or duodenitis (2.7%). We found ulcers in 6.7% of patients. Pathology was consistent with H. pylori in 9.8% of biopsies taken and consistent with BE in 2.7%. Following routine p-EGD, 11.2% of patients were placed on PPI and 8.3% were recommended to stop NSAIDs. CONCLUSION Gastroesophageal reflux disease and associated pathology are common in the bariatric population. Preoperative EGD in patients undergoing bariatric surgery frequently identifies clinically significant UGI pathology. This may have important implications for medical and surgical management. Given the rate of abnormal preoperative endoscopic findings in obese patients, the work-up for bariatric surgery should align with the current recommendations for foregut surgery.
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24
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Chiappetta S, Lainas P, Kassir R, Valizadeh R, Bosco A, Kermansaravi M. Gastroesophageal Reflux Disease as an Indication of Revisional Bariatric Surgery-Indication and Results-a Systematic Review and Metanalysis. Obes Surg 2022; 32:3156-3171. [PMID: 35776239 DOI: 10.1007/s11695-022-06183-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022]
Abstract
This systematic review evaluates the indications and results of revisional bariatric surgery (RBS) in gastroesophageal reflux disease (GERD). A systematic literature search and meta-analysis was performed for articles published by April 1, 2021. After examining 722 papers involving 17,437 patients, 48 studies were included (n = 915 patients). RBS for GERD was mostly reported after sleeve gastrectomy (n = 796, 87%) and one anastomosis gastric bypass (n = 62, 6.8%) and was performed due to intractable GERD (71.6%), GERD and weight issues (16%), and biliary reflux (6.2%). Mean follow-up of the studies was 31.5 (3-84) months. Pooled estimation of a meta-analysis of studies reported 7% of GERD following primary surgery needing RBS, in which 99% of the patients experienced remission.
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Affiliation(s)
- Sonja Chiappetta
- Bariatric and Metabolic Surgery Unit, Department of General Surgery, Ospedale Evangelico Betania, Via Argine 604, 80147, Naples, Italy.
| | - Panagiotis Lainas
- Department of Digestive Surgery, Metropolitan Hospital, HEAL Academy, Athens, Greece
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Clamart, France
| | - Radwan Kassir
- Digestive Surgery Unit, University Hospital of La Réunion -Félix Guyon Hospital, Saint-Denis, La Réunion, France
- Diabète Athérothrombose Thérapies Réunion Océan Indien (DéTROI), UMR 1188, INSERM, Université de La Réunion, 97400, Saint Denis, France
| | - Rohollah Valizadeh
- Department of Epidemiology, School of Public Health, University of Medical Sciences, Tehran, Iran
| | - Alfonso Bosco
- Bariatric and Metabolic Surgery Unit, Department of General Surgery, Ospedale Evangelico Betania, Via Argine 604, 80147, Naples, Italy
| | - Mohammad Kermansaravi
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Department of SurgeryRasool-E Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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25
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Kermansaravi M, Parmar C, Chiappetta S, Shahabi S, Abbass A, Abbas SI, Abouzeid M, Antozzi L, Asghar ST, Bashir A, Bhandari M, Billy H, Caina D, Campos FJ, Carbajo MA, Chevallier JM, Jazi AHD, de Gordejuela AGR, Haddad A, ElFawal MH, Himpens J, Inam A, Kassir R, Kasama K, Khan A, Kow L, Kular KS, Lakdawala M, Layani LA, Lee WJ, Luque-de-León E, Loi K, Mahawar K, Mahdy T, Musella M, Nimeri A, González JCO, Pazouki A, Poghosyan T, Prager G, Prasad A, Ramos AC, Rheinwalt K, Ribeiro R, Ruiz-Úcar E, Rutledge R, Shabbir A, Shikora S, Singhal R, Taha O, Talebpour M, Verboonen JS, Wang C, Weiner R, Yang W, Vilallonga R, De Luca M. Patient Selection in One Anastomosis/Mini Gastric Bypass-an Expert Modified Delphi Consensus. Obes Surg 2022; 32:2512-2524. [PMID: 35704259 DOI: 10.1007/s11695-022-06124-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE One anastomosis/mini gastric bypass (OAGB/MGB) is up to date the third most performed obesity and metabolic procedure worldwide, which recently has been endorsed by ASMBS. The main criticisms are the risk of bile reflux, esophageal cancer, and malnutrition. Although IFSO has recognized this procedure, guidance is needed regarding selection criteria. To give clinicians a daily support in performing the right patient selection in OAGB/MGB, the aim of this paper is to generate clinical guidelines based on an expert modified Delphi consensus. METHODS A committee of 57 recognized bariatric surgeons from 24 countries created 69 statements. Modified Delphi consensus voting was performed in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was considered to indicate a consensus. RESULTS Consensus was achieved for 56 statements. Remarkably, ≥ 90.0% of the experts felt that OAGB/MGB is an acceptable and suitable option "in patients with Body mass index (BMI) > 70, BMI > 60, BMI > 50 kg/m2 as a one-stage procedure," "as the second stage of a two-stage bariatric surgery after Sleeve Gastrectomy for BMI > 50 kg/m2 (instead of BPD/DS)," and "in patients with weight regain after restrictive procedures. No consensus was reached on the statement that OAGB/MGB is a suitable option in case of resistant Helicobacter pylori. This is likely as there is a concern that this procedure is associated with reflux and its related long-term complications including risk of cancer in the esophagus or stomach. Also no consensus reached on OAGB/MGB as conversional surgery in patients with GERD after restrictive procedures. Consensus for disagreement was predominantly achieved "in case of intestinal metaplasia of the stomach" (74.55%), "in patients with severe Gastro Esophageal Reflux Disease (GERD)(C,D)" (75.44%), "in patients with Barrett's metaplasia" (89.29%), and "in documented insulinoma" (89.47%). CONCLUSION Patient selection in OAGB/MGB is still a point of discussion among experts. There was consensus that OAGB/MGB is a suitable option in elderly patients, patients with low BMI (30-35 kg/m2) with associated metabolic problems, and patients with BMIs more than 50 kg/m2 as one-stage procedure. OAGB/MGB can also be a safe procedure in vegetarian and vegan patients. Although OAGB/MGB can be a suitable procedure in patients with large hiatal hernia with concurrent hiatal hernia, it should not be offered to patients with grade C or D esophagitis or Barrett's metaplasia.
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Affiliation(s)
- Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Sonja Chiappetta
- Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Shahab Shahabi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alaa Abbass
- Bariatric Surgery Unit, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
| | | | - Mohamed Abouzeid
- Bariatric Surgery Unit, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
| | | | | | - Ahmad Bashir
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Amman, Jordan
| | | | - Helmuth Billy
- Ventura Advanced Surgical Associates, Ventura, CA, USA
| | - Daniel Caina
- Dr. Federico Abete Hospital for Trauma and Emergency, Obesity and Metabolic Center, Malvinas, Argentina
| | | | - Miguel-A Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain
| | | | - Amir Hossein Davarpanah Jazi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ashraf Haddad
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Amman, Jordan
| | | | - Jacques Himpens
- Bariatric Surgery Unit, Delta Chirec Hospital, Brussels, Belgium
| | - Aatif Inam
- Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Amir Khan
- Walsall Healthcare NHS Trust, Walsall, UK
| | - Lilian Kow
- Flinders Medical Centre, Adelaide, Australia
| | | | | | | | - Wei-Jei Lee
- Min-Sheng General Hospital, Taoyuan City, Taiwan
| | | | - Ken Loi
- St George Surgery, Sydney, Australia
| | - Kamal Mahawar
- South Tyneside and Sunderland Foundation NHS Trust, Sunderland, UK
| | - Tarek Mahdy
- Mansoura Faculty of Medicine, Sharjah University Hospital, Sharjah, UAE
| | - Mario Musella
- Advanced Biomedical Sciences Department, "Federico II" University, Naples, Italy
| | | | | | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Tigran Poghosyan
- Hôpital Européen-Georges Pompidou, AP-HP, Université de Paris, Paris, France
| | | | | | | | - Karl Rheinwalt
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus Hospital, Cologne, Germany
| | - Rui Ribeiro
- Centro de Excelencia Para a Cirurgia MetabolicaGrupo Lusiadas, Lisbon, Portugal
| | - Elena Ruiz-Úcar
- Bariatric and Metabolic Surgery Department, University Hospital of Fuenlabrada, Madrid, Spain
| | - Robert Rutledge
- International Center for Laparoscopic Obesity Surgery, Punjab, India
| | - Asim Shabbir
- National University of Singapore, Singapore, Singapore
| | - Scott Shikora
- Department of Surgery Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rishi Singhal
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Osama Taha
- Plastic and Obesity Surgery Department, Bariatric Unit, Assiut University Hospital, Assiut, Egypt
| | - Mohammad Talebpour
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Rudolf Weiner
- Bariatric Surgery Unit, Sana Clinic Offenbach, Offenbach, Germany
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ramon Vilallonga
- Endocrine, Bariatric and Metabolic Surgery Department, Universitary Hospital Vall Hebron, Barcelona, Spain
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