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Valadares EC, Gestic MA, Utrini MP, Chaim FDM, Chaim EA, Cazzo E. PRE-OPERATIVE SCREENING OF HELICOBACTER PYLORI IN BARIATRIC PATIENTS: IS HISTOPATHOLOGICAL ANALYSIS NECESSARY? ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:275-280. [PMID: 35830041 DOI: 10.1590/s0004-2803.202202000-49] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Helicobacter pylori infection has been reported to lead to post-operative complications after bariatric surgery (BS), especially marginal ulcers. The optimal method for pre-operative screening is yet to be determined. OBJECTIVE To analyze the diagnostic accuracy of the endoscopic urease test for the detection of H. pylori in individuals undergoing BS and the main endoscopic and histological changes within this population. METHODS A cross-sectional study was carried out based on a database from medical records of 232 individuals who underwent BS between 2016 and 2019 at a tertiary university hospital. Clinical, anthropometric, and endoscopic data were analyzed. The gold-standard method considered to calculate diagnostic accuracy variables was histopathological examination through hematoxylin-eosin/Giemsa stains. RESULTS 87.5% of the participants were female; mean age was 38.5±9.5 years and average body mass index was 37.6±3.8 kg/m2. The commonest endoscopic finding was gastritis (50.9%) with a predominance of the mild erosive form (25%). Upon histological examination, 59.1% of the participants had confirmed H. pylori infection. H. pylori infection was associated with higher frequencies of endoscopic duodenitis (23.4% vs 12.6%; P=0.04), histological chronic gastritis (100% vs 56.8%; P<0.0001) and histological acute gastritis (58.4% vs 2.1%; P<0.0001). The urease test had a sensitivity of 79.6% and a specificity of 97.9%, leading to an overall accuracy of 87.1%. CONCLUSION The endoscopic urease test is highly accurate for pre-operative screening of H. pylori infection in individuals who undergo BS. H. pylori infection was significantly associated with endoscopic (duodenitis) and histopathological (chronic and active gastritis) changes.
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Affiliation(s)
- Erick Coelho Valadares
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Martinho Antonio Gestic
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Murillo Pimentel Utrini
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Felipe David Mendonça Chaim
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Elinton Adami Chaim
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Everton Cazzo
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
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Fisher OM, Chan DL, Talbot ML, Ramos A, Bashir A, Herrera MF, Himpens J, Shikora S, Higa KD, Kow L, Brown WA. Barrett's Oesophagus and Bariatric/Metabolic Surgery-IFSO 2020 Position Statement. Obes Surg 2021; 31:915-934. [PMID: 33460005 DOI: 10.1007/s11695-020-05143-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/07/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022]
Abstract
The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has been playing an integral role in educating both the metabolic surgical and the medical community at large about the importance of surgical and/or endoscopic interventions in treating adiposity-based chronic diseases. The occurrence of chronic conditions following bariatric/metabolic surgery (BMS), such as gastro-oesophageal reflux disease (GERD) and columnar (intestinal) epithelial metaplasia of the distal oesophagus (also known as Barrett's oesophagus (BE)), has long been discussed in the metabolic surgical and medical community. Equally, the risk of neoplastic progression of Barrett's oesophagus to oesophageal adenocarcinoma (EAC) and the resulting requirement for surgery are the source of some concern for many involved in the care of these patients, as the surgical alteration of the gastrointestinal tract may lead to impaired reconstructive options. As such, there is a requirement for guidance of the community.The IFSO commissioned a task force to elucidate three aspects of the presenting problem: First, to determine what the estimated incidence of Barrett's oesophagus is in patients presenting for BMS; second, to determine the frequency at which Barrett's oesophagus may develop following BMS (with a particular focus on the laparoscopic sleeve gastrectomy (LSG)); and third, to determine if regression of Barrett's oesophagus may occur following BMS given the close relationship of obesity and the development of BE/EAC. Based on these findings, a position statement regarding the management of this pathology in the context of BMS was developed. The following position statement is issued by the IFSO Barrett's Oesophagus task force andapproved by the IFSO Scientific Committee and Executive Board. This statement is based on current clinical knowledge, expert opinion and published peer-reviewed scientific evidence. It will be reviewed regularly.
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Affiliation(s)
- Oliver M Fisher
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Daniel L Chan
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Michael L Talbot
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Almino Ramos
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Ahmad Bashir
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Miguel F Herrera
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Jacques Himpens
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Scott Shikora
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Kelvin D Higa
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Lilian Kow
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Wendy A Brown
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy. .,Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia.
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Ooi GJ, Browning A, Hii MW, Read M. Perioperative screening, management, and surveillance of Barrett's esophagus in bariatric surgical patients. Ann N Y Acad Sci 2020; 1481:224-235. [PMID: 32794237 DOI: 10.1111/nyas.14441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/06/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022]
Abstract
Obesity is a strong risk factor for Barrett's esophagus (BE), the only proven precursor lesion to esophageal adenocarcinoma (EAC). Bariatric surgery is currently the only reliable treatment that achieves long-term sustained weight loss; however, it can markedly affect the development of de novo BE, and the progression or regression of existing BE. Bariatric procedures may also have implications on future surgical management of any consequent EAC. In this review, we examine the current evidence and published guidelines for BE in bariatric surgery. Current screening practices before bariatric surgery vary substantially, with conflicting recommendations from bariatric societies. If diagnosed, the presence of BE may alter the type of bariatric procedure. A selective screening approach prevents unnecessary endoscopy; however, there is poor symptom correlation with disease. Studies suggest that sleeve gastrectomy predisposes patients to gastroesophageal reflux and de novo BE. Conversely, Roux-en-Y gastric bypass is associated with decreased reflux and potential improvement or resolution of BE. There are currently no guidelines addressing the surveillance for BE following bariatric surgery. BE is an important consideration in the management of bariatric surgical patients. Evidence-based recommendations are required to guide procedure selection and postoperative surveillance.
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Affiliation(s)
- Geraldine J Ooi
- Department of Surgery, Central Clinical School, Monash University, Prahran, Victoria, Australia
| | - Alison Browning
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Michael W Hii
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia.,Department of Surgery, the University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Matthew Read
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia.,Department of Surgery, the University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia
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Esophagitis After Bariatric Surgery: Large Cross-sectional Assessment of an Endoscopic Database. Obes Surg 2019; 30:161-168. [DOI: 10.1007/s11695-019-04164-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Mendes-Filho AM, Godoy ESN, Alhinho HCAW, Galvão-Neto MDP, Ramos AC, Ferraz ÁAB, Campos JM. FUNDOPLICATION CONVERSION IN ROUX-EN-Y GASTRIC BYPASS FOR CONTROL OF OBESITY AND GASTROESOPHAGEAL REFLUX: SYSTEMATIC REVIEW. ACTA ACUST UNITED AC 2018; 30:279-282. [PMID: 29340554 PMCID: PMC5793148 DOI: 10.1590/0102-6720201700040012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/21/2017] [Indexed: 12/12/2022]
Abstract
Introduction: Obesity is related with higher incidence of gastroesophageal reflux disease.
Antireflux surgery has inadequate results when associated with obesity, due
to migration and/or subsequent disruption of antireflux wrap. Gastric
bypass, meanwhile, provides good control of gastroesophageal reflux. Objective: To evaluate the technical difficulty in performing gastric bypass in
patients previously submitted to antireflux surgery, and its effectiveness
in controlling gastroesophageal reflux. Methods: Literature review was conducted between July to October 2016 in Medline
database, using the following search strategy: (“Gastric bypass” OR
“Roux-en-Y”) AND (“Fundoplication” OR “Nissen ‘) AND (“Reoperation” OR
“Reoperative” OR “Revisional” OR “Revision” OR “Complications”). Results: Were initially classified 102 articles; from them at the end only six were
selected by exclusion criteria. A total of 121 patients were included, 68
women. The mean preoperative body mass index was 37.17 kg/m² and age of
52.60 years. Laparoscopic Nissen fundoplication was the main prior
antireflux surgery (70.58%). The most common findings on
esophagogastroduodenoscopy were esophagitis (n=7) and Barrett’s esophagus
(n=6); the most common early complication was gastric perforation (n=7), and
most common late complication was stricture of gastrojejunostomy (n=9).
Laparoscopic gastric bypass was performed in 99 patients, with an average
time of 331 min. Most patients had complete remission of symptoms and
efficient excess weight loss. Conclusion: Although technically more difficult, with higher incidence of complications,
gastric bypass is a safe and effective option for controlling
gastroesophageal reflux in obese patients previously submitted to antireflux
surgery, with the added benefit of excess weight loss.
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Affiliation(s)
| | | | | | | | | | - Álvaro Antônio Bandeira Ferraz
- Post-Graduation Program in Surgery, Federal University of Pernambuco, Recife, PE.,Department of Surgery and Clinical Medicine, Federal University of Pernambuco, Recife, PE, Brazil
| | - Josemberg Marins Campos
- Post-Graduation Program in Surgery, Federal University of Pernambuco, Recife, PE.,Department of Surgery and Clinical Medicine, Federal University of Pernambuco, Recife, PE, Brazil
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Lasnibat JP, Braghetto I, Gutierrez L, Sanchez F. SLEEVE GASTRECTOMY AND FUNDOPLICATION AS A SINGLE PROCEDURE IN PATIENTS WITH OBESITY AND GASTROESOPHAGEAL REFLUX. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2017; 30:216-221. [PMID: 29019565 PMCID: PMC5630217 DOI: 10.1590/0102-6720201700030012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/04/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Bariatric surgery in Chile has seen an exponential increase in recent years, especially in sleeve gastrectomy. Its use is currently discussed in patients suffering from gastroesophageal reflux disease. Different options have been considered for the management of these patients but up to now laparoscopic Roux-en-Y gastric bypass seems to be the best option. Sleeve gastrectomy plus concomitant fundoplication or hiatal hernia repair also has been suggested in patients having reflux or small hiatal hernia. AIM To present a cohort of obese patients with gatroesophageal reflux undergoing this procedure, which seeks to provide the benefits of both laparoscopic gastric sleeve (LSG) and antireflux surgery focused on the evaluation of presence of reflux and BMI after surgery, and to compare the result observed in this cohort with a previous group of obese patients without reflux submitted to sleeve gastrectomy alone. METHODS Retrospective case series in 15 patients who underwent this surgery between the years 2003 and 2012. Clinical records were analyzed and values of 24 hr pH monitoring, esophageal manometry and clinical outcome were recorded. Results were compared to a previous series of patients who underwent LSG. No statistical analyses were made. RESULTS Group A consisted of 15 patients submitted to LSG plus fundoplication. 93% (n=14) were female. Mean age was 46.2 years. Mean preoperative body mass index (BMI) was 33.9. All patients had altered pH monitoring and manometry preoperatively. There was one minor complication corresponding to a seroma. There was no perioperative mortality. Group B consisted of 23 obese patients who underwent LSG. These patients developed de novo reflux, hypotensive LES and esophagitis after the surgery. Group A patients showed improvement in esophageal pH monitoring and manometry at three months. During long-term follow-up, six underwent revision surgery, four for weight regain, one regained weight associated with symptomatic reflux, and one underwent re-intervention for reflux. CONCLUSIONS Good results are observed in the short-term follow up in both reflux resolution and weight loss. Nevertheless, results at long term are discouraging, with 53.3% of the patients requiring revision surgery during follow-up.
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Affiliation(s)
- Juan Pablo Lasnibat
- Department of Surgery, Faculty of Medicine, University Hospital Dr José J. Aguirre, Santiago, Chile
| | - Italo Braghetto
- Department of Surgery, Faculty of Medicine, University Hospital Dr José J. Aguirre, Santiago, Chile
| | - Luis Gutierrez
- Department of Surgery, Faculty of Medicine, University Hospital Dr José J. Aguirre, Santiago, Chile
| | - Felipe Sanchez
- Department of Surgery, Faculty of Medicine, University Hospital Dr José J. Aguirre, Santiago, Chile
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Rodrigues RSN, Almeida ÉCDS, Camilo SMP, Terra-Júnior JA, Guimarães LC, Duque ACDR, Etchebehere RM. GASTRIC AND JEJUNAL HISTOPATHOLOGICAL CHANGES IN PATIENTS UNDERGOING BARIATRIC SURGERY. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 29Suppl 1:35-38. [PMID: 27683773 PMCID: PMC5064251 DOI: 10.1590/0102-6720201600s10010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/24/2016] [Indexed: 01/30/2023]
Abstract
Background: Morbid obesity is a multifactorial disease that increasingly is being treated by
surgery. Aim: To evaluate gastric histopathological changes in obese, and to compare with
patients who underwent gastrojejunal bypass and the jejunal mucosa after the
surgery. Methods: This is an observational study performed at a tertiary public hospital, evaluating
endoscopic biopsies from 36 preoperative patients and 35 postoperative. Results: In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9%
(77.1% and 20.1%, respectively, in the postoperative). The postoperative group had
a significant reduction in H. pylori infection (p=0.0001). A longer length of the
gastric stump and a time since surgery of more than two years were associated with
Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed
slight nonspecific chronic inflammation in 8.6%. Conclusion: There was a reduction in the incidence of Helicobacter pylori infection in the
postoperative group. A longer length of the gastric stump and longer time elapsed
since surgery were associated with Helicobacter pylori infection. The jejunal
mucosa was considered normal in an absolute majority of patients.
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Affiliation(s)
| | | | - Silvia Maria Perrone Camilo
- Universidade Federal do Triângulo Mineiro (Triângulo Mineiro Federal University - UFTM), Uberaba, MG, Brazil
| | - Júverson Alves Terra-Júnior
- Universidade Federal do Triângulo Mineiro (Triângulo Mineiro Federal University - UFTM), Uberaba, MG, Brazil
| | - Lucinda Calheiros Guimarães
- Universidade Federal do Triângulo Mineiro (Triângulo Mineiro Federal University - UFTM), Uberaba, MG, Brazil
| | - Ana Cristina da Rocha Duque
- Universidade Federal do Triângulo Mineiro (Triângulo Mineiro Federal University - UFTM), Uberaba, MG, Brazil
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