Abstract
PurposeExcellent metabolic improvement following one anastomosis gastric bypass (OAGB) remains compromised by the risk of esophageal bile reflux and theoretical carcinogenic potential. No ‘gold standard’ investigation exists for esophageal bile reflux, with diverse methods employed in the few studies evaluating it post-obesity surgery. As such, data on the incidence and severity of esophageal bile reflux is limited, with comparative studies lacking. This study aims to use specifically tailored biliary scintigraphy and upper gastrointestinal endoscopy protocols to evaluate esophageal bile reflux after OAGB, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).MethodsFifty-eight participants underwent OAGB (20), SG (15) or RYGB (23) between November 2018 and July 2020. Pre-operative reflux symptom assessment and gastroscopy were performed and repeated post-operatively at 6 months along with biliary scintigraphy.ResultsGastric reflux of bile was identified by biliary scintigraphy in 14 OAGB (70%), one RYGB (5%) and four SG participants (31%), with a mean of 2.9% (SD 1.5) reflux (% of total radioactivity). One participant (OAGB) demonstrated esophageal bile reflux. De novo macro- or microscopic gastroesophagitis occurred in 11 OAGB (58%), 8 SG (57%) and 7 RYGB (30%) participants. Thirteen participants had worsened reflux symptoms post-operatively (OAGB, 4; SG, 7; RYGB, 2). Scintigraphic esophageal bile reflux bore no statistical association with de novo gastroesophagitis or reflux symptoms.ConclusionDespite high incidence of gastric bile reflux post-OAGB, esophageal bile reflux is rare. With scarce literature of tumour development post-OAGB, frequent low-volume gastric bile reflux likely bears little clinical consequence; however, longer-term studies are needed.Clinical Trial RegistryAustralian New Zealand Clinical Trials Registry number ACTRN12618000806268.Graphical abstract
Highlights
The one anastomosis gastric bypass (OAGB) is deservedly the third-most performed metabolic and obesity surgery (MOS) procedure globally [1]
This study aims to elucidate the incidence and severity of esophageal bile reflux post-OAGB, with direct comparison to sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), by utilising a developed diagnostic protocol tailored for a post-MOS cohort
Nine participants were excluded after enrolment and 13 withdrew; 58 participants were evaluated before and after surgery: OAGB, n = 20; SG, n = 15; and RYGB, n = 23
Summary
The one anastomosis gastric bypass (OAGB) is deservedly the third-most performed metabolic and obesity surgery (MOS) procedure globally [1]. OAGB has not been adopted with enthusiasm, due to concerns around the potential impact of post-operative esophageal bile reflux. This is often termed duodenogastroesophageal reflux (DGER), but strictly, this is not a correct term regarding post-OAGB anatomy. The potential for bile reflux stems from the anatomical similarities with both the Mason gastric bypass and the Billroth II procedure, both of which were controversially associated with both duodenogastric and esophageal bile reflux and a potential cancer risk. No gold standard investigation exists to diagnose esophageal bile reflux, and heterogenous diagnostic protocols are evident in the few studies
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
