Long-term consequences of one anastomosis gastric bypass on esogastric mucosa in a preclinical rat model

Dominique Rainteau,Maude Le Gall,Nicholas D Nguyen,Henri Duboc,Matthieu Siebert,André Bado,Jean-Marc Chevallier,Lara Ribeiro-Parenti,Grégory Nuel,Belinda Duchêne,Nicolas Jonckheere,Simon Msika,Lydie Humbert,Muriel Hourseau,Nathalie Kapel,Anne Couvelard

doi:10.1038/s41598-020-64425-2

Abstract

Although bariatric surgery is proven to sustain weight loss in morbidly obese patients, long-term adverse effects have yet to be fully characterized. This study compared the long-term consequences of two common forms of bariatric surgery: one-anastomosis gastric bypass (OAGB) and Roux-en-Y Gastric Bypass (RYGB) in a preclinical rat model. We evaluated the influence of biliopancreatic limb (BPL) length, malabsorption, and bile acid (BA) reflux on esogastric mucosa. After 30 weeks of follow-up, Wistar rats operated on RYGB, OAGB with a short BPL (15 cm, OAGB-15), or a long BPL (35 cm, OAGB-35), and unoperated rats exhibit no cases of esogastric cancer, metaplasia, dysplasia, or Barrett’s esophagus. Compared to RYGB, OAGB-35 rats presented higher rate of esophagitis, fundic gastritis and perianastomotic foveolar hyperplasia. OAGB-35 rats also revealed the greatest weight loss and malabsorption. On the contrary, BA concentrations were the highest in the residual gastric pouch of OAGB-15 rats. Yet, no association could be established between the esogastric lesions and malabsorption, weight loss, or gastric bile acid concentrations. In conclusion, RYGB results in a better long-term outcome than OAGB, as chronic signs of biliary reflux or reactional gastritis were reported post-OAGB even after reducing the BPL length in a preclinical rat model.

Highlights

Bariatric surgery is widely accepted as a long-term effective treatment for morbid obesity and ensuing metabolic disorders[1]
The first two cases of adenocarcinoma of the esophagogastric junction (AEG) following One anastomosis gastric bypass (OAGB) have been recently reported; the first reported a carcinoma of the gastric cardia (AEG II)[20] and the second reported an adenocarcinoma of the esophagus (AEG I)[21]
Following 30 weeks post-OAGB and -Roux-en-Y gastric bypass (RYGB), we showed that no rats displayed signs of metaplasia, dysplasia, Barrett’s esophagus, or esogastric cancer

Summary

Introduction

Bariatric surgery is widely accepted as a long-term effective treatment for morbid obesity and ensuing metabolic disorders[1]. OAGB, as all Omega-loop surgical strategies, is characterized by the direct anastomosis of the biliopancreatic loop to the stomach, instead of interposing an alimentary loop as in the Roux-en-Y procedures This anatomically exposes the esogastric tract to bile acids (BA). Few cases of gastric cancer have been reported after omega-loop gastric bypass, an operation following similar principles to those of OAGB. Three of these cancers were located in the region of the stomach excluded from the alimentary tract and only one of these cancers was located in the gastric pouch[10]. We previously explored the middle-term consequences of OAGB-induced biliary reflux on rats after 16 weeks and did not report an increased risk for esogastric cancer[30]

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