Biliary Gastritis Research Articles

590. RESOLUTION OF SYMPTOMS AFTER OESOPHAGO-GASTRIC CANCER RESECTION (RESTORED)–STANDARDISING GASTROINTESTINAL SYMPTOMS AND CONDITIONS AFTER SURGERY: A MULTI-DISCIPLINARY EXPERT DELPHI STUDY

Abstract Background Oesophago-gastric cancer surgery negatively affects quality of life with a high post-operative symptom burden. Several conditions that may be diagnosed and treated after surgery are recognised. However, consensus regarding their definition and management is lacking. We aimed to develop consensus regarding the definition, investigation and management of the common symptoms and conditions, and triggers to consider disease recurrence, as a foundation for improving management and quality of life in these patients. Design Modified 2-round Delphi consensus study of a multidisciplinary expert panel. Results 86/127(67.7%) and 77/100(77.0%) responses were received in rounds 1 and 2. Consensus was achieved in defining 26 symptoms. For 10 conditions (anastomotic stricture, acid reflux, non-acid reflux, biliary gastritis, delayed gastric emptying, dumping syndrome, exocrine pancreatic insufficiency, bile acid diarrhoea, small intestinal bacterial overgrowth and carbohydrate malabsorption), definitions, diagnostic criteria, first and second-line investigation and first-line treatments were agreed. Consensus was not reached for third line investigation of some conditions, nor for second, third or fourth-line treatments for others. 12 of 14(85.7%) symptoms were agreed as triggers to consider cancer recurrence, during the early (< 1 year) and late (> 1 year) post-operative periods. Conclusion Expert consensus regarding symptoms, conditions and triggers to consider investigation for recurrence after oesophago-gastric cancer surgery was achieved. This will allow standardisation and timely diagnosis and treatment of post-operative conditions, reducing variation in care. It will facilitate comparative, prospective research to establish the incidence and response to treatment of these conditions, helping develop robust evidence to optimise patients’ quality of life.

Assessment of Anti-Reflux Suture in One Anastomosis Gastric Bypass for Prevention of Biliary Gastritis

Abstract Background Obesity continues to be a leading public health concern associated with many comorbidities and major hindering effect on the daily lifestyle of many people around the world. Surgical treatment for obesity has proved that it is the best and most effective, durable means of preventing the life-threatening complications and serious problems associated with morbid obesity. Objective Assessing the effect of the anti-reflux suture on the incidence and clinical consequences of bile reflux in OAGB Procedure. Patients and Methods In this prospective randomized study, 30 patients were selected in Ain Shams University hospitals between November 2021 and May 2022 for assessment of impact of Anti reflux suture on the incidence of post OAGB biliary gastritis. Results The cases presented in this study did not undergo upper GI endoscopy when they presented with symptoms of reflux or gastritis and thus it was not possible to differentiate between the presence of GERD or biliary gastritis as the source of their symptoms. Conclusion OAGB is safe and one of the leading procedures for treatment of obesity but it is still surrounded by controversy regarding its relation and effect on bile reflux gastritis. As far as this study shows, the anti-reflux suture modification alone does not seem to prevent the incidence of biliary reflux gastritis post OAGB.

Принципы диагностики хронического гастрита, ассоциированного с патологическим дуоденогастральным рефлюксом: серия клинических наблюдений

In recent years in the structure of the incidence of chronic gastritis, there has been a decrease in the proportion of Helicobacter pylori-associated gastritis, but the contribution of other etiological factors is increasing. In addition to H. pylori, one of the most frequently diagnosed gastritis in real clinical practice is chemical gastritis, associated with the development of pathological duodenogastric reflux. The increase in prevalence makes the issue of diagnosing biliary gastritis relevant. This publication was prepared with the aim of systematizing and analyzing available data on the incidence, risk factors, mechanisms of formation, as well as clinical, endoscopic and pathomorphological signs of biliary gastritis and is illustrated by a series of observations from real clinical practice.

OGC P28 Gastrointestinal symptoms and disorders after oesophago-gastric cancer surgery: The RESTORE modified Delphi survey

Abstract Background Oesophago-gastric (OG) cancer surgery is life-changing with a significant impact on quality of life (QOL). OG cancer surgery reconfigures the upper gastrointestinal (GI) tract altering its physiological function. Certain disorders such as anastomotic stricture are well recognised whereas others, such as small intestinal bacterial overgrowth, are increasingly being diagnosed. As multimodality treatment improves survival, more poly-symptomatic patients are living with these disorders as a consequence of surgery. We aimed to establish consensus on the definitions of relevant symptoms and disorders, as well as appropriate investigation and treatment. Standardisation will form a foundation for optimising QOL in this growing patient group. Methods This on-line modified Delphi study focused on patients after oesophagectomy, gastrectomy or subtotal gastrectomy for cancer (OG cancer surgery). The survey covered symptoms, common conditions, and symptoms triggering investigation for recurrence. The survey was designed using non-systematic reviews and expert opinion. Items were rated from 1 (completely disagree) to 9 (absolutely agree). Multi-disciplinary experts were identified through word of mouth and expressions of interest at previous conferences. Two rounds were completed, with some revisions after first round review. Median ratings were determined. Consensus agreement was judged as 70% or more respondents in agreement (7-9) and less than 15% disagreement (1-3). Results 86 and 77 complete surveys were received in rounds 1 and 2. Respondents were multidisciplinary, including OG surgeons, oncologists, gastroenterologists, radiologists, dietitians and nurse specialists. 7 upper GI, 13 non-specific and 6 lower GI symptom definitions were agreed. Clinical definitions, diagnostic criteria, first line investigations and treatments were agreed for 10 conditions: anastomotic stricture, acid reflux, non-acid reflux oesophagitis, biliary gastritis, delayed gastric emptying, dumping syndrome, exocrine pancreatic insufficiency, bile acid diarrhoea, small intestinal bacterial overgrowth and carbohydrate malabsorption. Agreement was also reached across many second-line investigations and treatments, and 12 of 14 (86%) symptom triggers to investigate for recurrence. Conclusions The RESTORE multidisciplinary consensus study has established a foundation for assessing and treating 10 conditions negatively affecting QOL after OG cancer surgery. Standardised symptom definitions will guide diagnostic assessments. Agreed condition definitions and diagnostic criteria will allow robust measurement of their incidence, and evaluation of treatment effects. Future work will aim to develop algorithms for managing these conditions. This work will raise standards of diagnosis and treatment of conditions that affect patients after OG cancer surgery, allowing collection of robust data to evaluate improvements in symptoms and QOL.

Biliary gastritis. Pathomorphological features and differential diagnosis

The review article discusses the modern pathogenetic links of biliary gastritis, namely the role of endothelial dysfunction, intestinal metaplasia in inflammation and the influence of Helicobacter pylori infection. The problem of combined damage to the mucous membrane of HP-associated and biliary gastritis remains relevant, since modern foreign studies have not come to a consensus, but most authors state increased carcinogenesis of the stomach with a positive HP status against the background of the course of pathological duodenogastric reflux. The article also presents original materials of histological examination of biliary, HP-associated, autoimmune and hyperplastic gastritis with similar morphological features, thereby demonstrating the difficulties of differential diagnosis.

Mid-term outcomes after single anastomosis sleeve ileal (SASI) bypass in treatment of morbid obesity

BackgroundAccording to several short-term studies, single-anastomosis sleeve ileal (SASI) bypass offers similar weight loss to Roux-en-Y Gastric Bypass (RYGB) with fewer complication and better comorbidity reduction/resolution. Long-term data on this operation is lacking in the literature. The purpose of this study was to analyze the outcomes of SASI bypass up to 4 years.MethodsThis study is a retrospective cohort analysis of 366 patients with morbid obesity who underwent primary SASI bypass from January 2018 to February 2022.ResultsThe mean age and preoperative body mass index (BMI) were 41 years (range 22–71 years) and 43.9 ± 6.5 kg/m2, respectively. Follow-up was available for 229 patients at 1-year (89%), 112 patients at 2-year (75%), 61 patients at 3-year (75%), and 35 patients at 4-year (71%). The intraoperative, short-term, and long-term complication rates were 0%, 2.5%, 4.6%, respectively. After 4 years, mean percentage excess weight loss (%EWL) was 93.3% and total weight loss (%TWL) was 41.2%. Remission of comorbidities was 93% for type 2 diabetes mellitus, 73% for hypertension, 83% for hyperlipidemia, 79% for sleep apnea, and 25% for gastroesophageal reflux disease (GERD). Biliary gastritis and ulcers are seldom. Eight patients developed de novo GERD symptoms requiring proton pump inhibitor treatment. None of the patients in our study had hypoalbuminemia or malabsorption that did not respond to increased protein intake and vitamin or mineral supplementation.ConclusionSASI bypass appears to be safe, and one of the most effective bariatric procedures regarding weight loss and obesity related comorbidities. The double-outlet created in this procedure seemingly minimizes nutritional complications.Graphical abstract

Diagnostic Principles for Chronic Gastritis Associated with Duodenogastric Reflux.

This article systematizes available data from the literature on biliary gastritis (BG) in order to increase the awareness of specialists about the latest possibilities for diagnosing the disease. BG occurs as a result of pathological duodenogastric reflux. In patients with a preserved duodenogastric junction, the dominant factor is represented by motor disorders of the upper digestive tract (primary biliary gastritis), while in patients recovering from surgical interventions it is represented by structural changes (secondary biliary gastritis). Progressive BG can lead to atrophy of the gastric mucosa, intestinal metaplasia, epithelial dysplasia, and eventually to gastric cancer. Diagnostic methods for BG are carried out to identify risk factors, exclude alarm symptoms and identify persistent motor disorders and pathological reflux (24 h pH-impedancemetry, hepatobiliary scintigraphy, 24 h monitoring of bilirubin content in the reflux using a Bilitec 2000 photometer), as well as to diagnose gastritis itself (esophagogastroduodenoscopy, morphological gastrobiopsy examination). The diagnosis of BG should be based on a multidisciplinary approach that combines a thorough analysis of a patient's complaints, an anamnesis of the disease, and the results of endoscopic and histological research methods.

Single-Anastomosis Sleeve Jejunal (SAS-J) Bypass as Revisional Surgery After Primary Restrictive Bariatric Procedures

PurposeSingle-anastomosis sleeve jejunal (SAS-J) bypass is the modification of a single-anastomosis sleeve ileal (SASI) bypass with a short biliary limb. SAS-J bypass is reported to be a good primary bariatric procedure. This study aimed to evaluate the results of SAS-J bypass as a revisional surgery after failed primary restrictive bariatric procedures.Material and MethodsThis was a prospective cohort study including 43 patients who underwent SAS-J bypass as a revisional surgery for weight regain after laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric band (LAGB), or laparoscopic gastric plication.ResultsOf the total patients, 35 (81.4%) were female, and 8 (18.6%) were male. The mean BMI was 46.3 kg/m2. The mean age was 41 years. Thirty-two patients (74.4%) had a failed sleeve, 9 (20.9%) had a failed LAGB, and 2 (4.7%) had a failed gastric plication. The mean operative time was 104 min. Intra-abdominal bleeding occurred in 1 case (2.3%), and intraluminal bleeding occurred in 3 cases (7%). No case (0%) developed a leak. The percentage of excess weight loss (%EWL) reached 76.5% after 1 year. Type 2 diabetes mellitus remission occurred in all diabetic patients, hypertension remitted in 80%, hyperlipidemia remitted in 83.3%, and obstructive sleep apnea syndrome improved in all cases. Gastroesophageal reflux disease (GERD) symptoms were improved in 86.7% of patients. Significant biliary gastritis occurred in 4 patients (9.3%). Dumping syndrome was reported in 4 patients (9.3%).ConclusionsSAS-J bypass was effective as a salvage surgery after failed restrictive bariatric procedures, but long-term follow-up is needed.Graphical abstract

Билиарный гастрит: современные подходы к диагностике и терапии

According to the prevalence, chronic biliary gastritis is among the most common etiological variants of chronic gastritis along with Helicobacter pylori associated gastritis and NSAID gastropathy. This review has been prepared to systematize data on the causes, pathogenetic mechanisms and methods of the diagnosis and therapy of chronic biliary gastritis. The widespread prevalance of biliary gastritis in clinical practice with insufficient understanding of the pathogenesis, the lack of diagnostic standards and unified treatment methods make the coverage of this problem very relevant. The review also systematizes known information about risk factors and pathogenetic mechanisms of biliary gastritis, discusses methods of the diagnosis and treatment of this disease, in particular, the use of ursodeoxycholic acid and cytoprotectors as pathogenetic therapy. The authors note that the treatment of biliary gastritis should be comprehensive and aimed not only at relieving dyspeptic symptoms and improving the life quality of patients, but also at preventing and inhibiting atrophic changes in the gastric mucosa. KEYWORDS: biliary gastritis, duodenogastric reflux, reactive gastritis, bile reflux gastropathy, reactive gastropathy, ursodeoxycholic acid, cytoprotectors. FOR CITATION: Livzan M.A., Gaus O.V., Mozgovoi S.I., Telyatnikova L.I. Biliary gastritis: modern methods of diagnosis and therapy. Russian Medical Inquiry. 2022;6(5):244–251 (in Russ.). DOI: 10.32364/2587-6821-2022-6-5-244-251.

Hepaticoduodenostomy for Biliary Reconstruction: A Retrospective Review of a Single-Centre Experience

Bile duct resection and reconstruction is a commonly performed surgical procedure for restoration of biliary flow. The most common techniques are Roux-en-Y hepaticojejunostomy (HJ) and hepaticoduodenostomy (HD). HJ has traditionally been preferred over concerns of increased risk of cholangitis and biliary gastritis with HD. However, there is minimal support for this preference in the literature. Studies suggests the two techniques are comparable with regards to complication rates and surgical outcomes when managing choledochal cysts, with slightly higher incidence of gastritis in HD.

Bile in excess

The article presents consideration for the pathogenetic mechanisms of the occurrence of duodenogastric reflux (DGR), duodenogastroesophageal reflux (DGER), their role in the occurrence of biliary reflux gastritis and reflux esophagitis. The fundamental bases for the formation of bile reflux are the failure of the sphincter apparatus, antroduodenal dysmotility, elimination of the natural antireflux barrier. Gallbladder dysfunction and duodenal dysmotility are considered the risk factors for primary DGR. The leading mechanism for the development of DGR, DGER after cholecystectomy is a violation of gastroduodenal motility and gastroduodenal hypertension. These syndromes are formed also at gallstone disease and other organic and functional pathological conditions, including pancreatic insufficiency. The syndrome of chronic duodenal hypertension or «duodenal demon» is manifested by heaviness in the epigastrium, belching, heartburn, nausea, vomiting, flatulence, and stool disorders. It is supplemented by the phenomena of psychosomatic asthenization, decreased mental and physical performance, apathy, and a negative assessment of life prospects. The clinical features of hologenous diarrhea are considered, differential diagnostic signs of diarrhea in chronic duodenal hypertension and irritable bowel syndrome are demonstrated.The clinical and pathogenetic substantiation of the treatment of chronic duodenal hypertension accompanied by hologenous diarrhea with colloidal bismuth preparations is presented. The summary of the comparative analysis has been presented of the physicochemical and structural properties of tablet formulations, containing bismuth tripotassium subcitrate, the original drug De‑Nol (Astellas) and the generic Ulcavis (KRKA). It has been concluded that it is advisable to include Ulcavis in the treatment regimen for patients with hologenous diarrhea.

Laparoscopic one anastomosis gastric bypass: a revisional procedure for failed open vertical banded gastroplasty in treatment of morbid obesity: a prospective study

Background The main indications for revision of bariatric surgery are inadequate weight loss, weight regain, or complications, so laparoscopic one anastomosis gastric bypass (LOAGB) is a promising bariatric procedure used as a revisional procedure for failed open vertical banded gastroplasty (VBG). Aim The aim was to evaluate LOAGB as a revisional bariatric procedure for failed open VBG regarding technical feasibility, weight loss, improvement in comorbidities, and complications. Patients and methods This prospective cohort study was carried out at the Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Tanta University, between October 2017 and October 2018. It included 20 patients who underwent LOAGB as a revisional bariatric procedure for failed open VBG. Results The study population included 17 females and three males, with a mean age of 38.25±5.36 years. The mean preoperative BMI was 48.15±4.35 kg/m2. The mean operative time was 145.36±25.19 min, and the mean postoperative hospital stay was 3.12 days. Neither conversion to open technique or to other bariatric procedures nor mortality occurred. Early complications were encountered in 3 patients (15%). Late complications included four (20%) patients. Severe biliary gastritis occurred in one (5%) patient, who was managed by side-to-side jejunojejunostomy. The mean postoperative excess body weight loss percent (EBWL%) achieved was 47.14±15.24 at 1 year and 60.85±12.17 at 2 years. The mean BMI achieved was 32.72±5.46 at 1 year and 28.14±4.45 at 2 years. Conclusion LOAGB surgery as a revisional procedure for failed open VBG is an effective bariatric surgical procedure producing significant weight loss and resolution or improvement of comorbidities with low perioperative complications.

Safra reflüsü bulunan ve bulunmayan gastrit hastalarında gastrik mukozal atrofi, intestinal metaplazi ve Helicobacter pylori durumu: Safra iyi mi kötü mü?

Background and Aims: To investigate the relation between bile reflux and gastric mucosal atrophy, intestinal metaplasia, and Helicobacter pylori status in patients with gastritis. Materials and Methods: A total of 217 patients (mean ± SD; age: 33.2±7.9 years; 51.2% males) with gastritis were divided into two groups: patients with intragastric bile reflux (n = 134; confirmed by pathology in 20 patients) and without bile reflux (control group; n = 83). The status of Helicobacter pylori and presence of intestinal metaplasia and gastric atrophy were evaluated with respect to the presence of bile reflux. Results: A positive Helicobacter pylori status, intestinal metaplasia, and gastric atrophy were observed in 85 (39.2%), 72 (33.2%), and 66 (30.4%) patients, respectively. No significant difference was noted between patients with gastritis with or without bile reflux in terms of a positive Helicobacter pylori status (38.8% vs. 45.8%), intestinal metaplasia (32.8% vs. 33.7%), and gastric atrophy (30.6% vs. 30.1%). However, the pathological confirmation of bile reflux gastritis was associated with a significantly lower rate of Helicobacter pylori positivity (0.0% vs. 45.6%; p = 0.001), intestinal metaplasia (5.0% vs. 37.7%; p = 0.009), and gastric atrophy (0.0% vs. 36.0%; p = 0.003). In patients with bile reflux (n = 134), the intestinal metaplasia and gastric mucosal atrophy rates were similar with respect to the H. pylori status. Conclusion: The rates of Helicobacter pylori positivity, intestinal metaplasia, and gastric atrophy were similar in patients with gastritis with or without bile reflux. However, the frequency of Helicobacter pylori, intestinal metaplasia, and gastric mucosal atrophy was lower in patients with pathologically confirmed biliary gastritis.

S1869 Transoral Gastric Outlet Reduction in a Patient With Billroth II Anastomosis for the Treatment of Severe Bile Acid Reflux

INTRODUCTION: Endoscopic transoral outlet reduction (TORe) utilizing a full thickness endoscopic suturing device is a minimally invasive therapeutic option in bariatric surgery patients who have experienced weight gain. This procedure can be therapeutic not only for weight gain after Roux-en-Y Gastric Bypass (RYGB), but also can be used in patients who underwent Billroth II procedure with biliary reflux symptoms. CASE DESCRIPTION/METHODS: A 68-year-old female patient with a past medical history of hypertension, dyslipidemia and prior Billroth II procedure for management of peptic ulcer disease presented with severe epigastric pain and bloating after meals refractory to PPI use. She underwent an EGD and was diagnosed with severe biliary gastritis. Transoral endoscopic gastric outlet reduction was recommended for this patient. A diagnostic flexible endoscope was advanced to the site of gastroduodenal anastomosis. Then, the gastric mucosa on the side of the anastomosis was aggressively ablated using argon plasma coagulation (APC). An endoscopic scissor was then used for trimming the previous suture remnants. A double channel scope was then inserted with the OverStitch device. A 2-0 Prolene suture was placed at the 3 O'clock position using full thickness running suture technique. A total of 4 bites were used. The suture was subsequently tightened with the creation of pseudo-pyloric opening. A total of one cinch was deployed to keep the suturing material permanently reinforced. No complications occurred throughout the procedure. Post-procedure follow up was normal with complete resolution of the patient's symptoms. DISCUSSION: Transoral endoscopic gastric outlet reduction is an emerging procedure used to manage weight gain after RYGB. The two-fold running suture technique is a novel method that can be used very effectively in this procedure. We have demonstrated that transoral outlet gastric reduction is not only effective for patients who have gained weight after RYGB, but also therapeutic in the improvement of biliary reflux symptoms after Billroth II procedure.Figure 1.: Argon plasma coagulation of the anastomotic margin.Figure 2.: Endoscopic suturing using the Apollo OverStitch device.Figure 3.: Creation of pseudo-pyloric opening.

The outcomes of single anastomosis sleeve jejunal bypass as a treatment for morbid obesity (Two-year follow-up).

Santoro's operation is a sleeve gastrectomy with transit bipartition. The aim of the procedure is to keep pass to the duodenum to decrease nutritional deficiency and to allow endoscopic management of obstructive jaundice. To be easier, this procedure was rapidly altered to a single anastomosis sleeve ileal bypass (SASI). In this study, we shifted the anastomosis up to the jejunum to evaluate the effect of laparoscopic single anastomosis sleeve jejunal (SASJ) bypass as a treatment for morbid obesity and related comorbidities. In addition, the effect of the SASJ procedure on nutritional deficiency was examined. In this study, 150 morbidly obese patients underwent SASJ bypass with a biliary limb length of 200-250cm. All patients were followed up at 1, 3, 6, 12, 18, and 24months. We evaluated all cases by assessing BMI, complications, nutritional status, and obesity-related comorbidities. The mean age of participants was 30.6years, and the mean body mass index (BMI) was 44.6kg/m2. Of the patients, 35 (23.2%) had type two diabetes and 47 (31.3%) were hypertensive. Postoperative bleeding occurred in two cases (1.3%). One patient developed a gastric leak (0.7%), and five patients developed biliary gastritis (3.3%). One patient (0.7%) developed a pulmonary embolism. The %EWL reached 85% in 1 year. Normalization of blood glucose occurred within 2 months after surgery in all diabetic patients. Hypertension underwent remittance in 89% of hypertensive patients. All patients were gradually weaned from four types of multivitamin regimens to only one multivitamin regimen without apparent nutritional deficiency. Laparoscopic SASJ bypass is an effective, safe, and simple procedure for treating morbid obesity and comorbid conditions with least nutritional deficiency. However, long-term studies are needed.

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

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.

Jejunoduodenal anastomosis as permanent biliary access loop post-hepaticojejunostomy: our experience

Background: Post-hepaticojejunostomy stricture is a common problem may result in liver cirrhosis and portal hypertension and death if not treated. Different modalities to repair it are available including endoscopic management that needs access loop (including jejuno-duodenal access loop) to reach the site of stricture.Methods: This prospective study was done in general surgery department, faculty of medicine, Zagazig University hospitals during the period from January 2016 to December 2018. The study included 23 patients (18 females and 5 males) all needed hepaticojejunostomy to treat biliary injuries during cholecystectomy, biliary stricture post-cholecystectomy or post-hepaticojejunostomy anastomotic stricture. Their ages ranged between 26 to 57 ys with mean age 37.3±5.1. The postoperative course of patients and the feasibility of postoperative endoscopic access to the hepaticojejunostomy and intrahepatic ductal system were assessed.Results: This study included 23 patients (18 females and 5 males) where 19 (82.6%) patients were presented post-cholecystectomy and 4 (17.4%) patients post-hepaticojejunostomy, with different modes of presentation postoperative complications included; 2 patients complicated with chest infection, 3 (13%) patients with wound seroma and infection, 2 (about 8.7%) patients complicated with biliary gastritis and 1 (about 4.4%) patient with mild attack of cholangitis. There was no anastomotic leakage or mortality in the studied group. The trial of access to the hepaticojejunostomy using gastroduodenoscopy was successful in all cases with ease including trial of balloon dilatation. The average hospital stay ranged between 5-7 days.Conclusions: Side-to-side jejunoduodenal anastomosis is a very useful technique as it provides good endoscopic access to hepaticojejunostomy and the intrahepatic ducts and needs more application and further evaluation.

Minigastric bypass: short-term results

Introduction Roux-en-y gastric bypass is a successful weight loss surgery together with a great impact on metabolic syndrome. Laparoscopic minigastric bypass is a new emerging bariatric surgery procedure with current debates on its efficacy and safety. Objectives The aim of this study was to evaluate the effect of laparoscopic minigastric bypass on weight loss, safety, and associated metabolic diseases. Patients and methods The study was performed in Menoufia University Hospital and other private hospitals in Kuwait. All patients underwent laparoscopic minigastric bypass and were followed up for 18 months. Its impact on BMI, %excess weight loss (%EWL), and associated metabolic diseases were reported and analyzed at 6, 12, and 18 months. Results A total of 80 patients were included in this study, of whom 49 were female. A total of 58 patients were diabetic, 62 patients were hypertensive, and 69 patients were dyslipidemic. The mean operative time was 92 ± 11.73 min. The mean %EWL was 77.3 ± 9.8%. The mean hospital length of stay was 3 days. One patient had anastomotic leak and two patients had biliary gastritis and were managed with Roux-en-Y gastric bypass. One patient showed marginal ulcer. A total of 47 patients with type 2 diabetes returned to normal glucose level. A total of 51 hypertensive patients became normotensives. A total of 59 patients showed complete improvement in lipid profile after 18 months. Conclusion Minigastric bypass is provisionally effective as other standard bariatric surgery procedures, with good impact on associated metabolic diseases.

Effects of omega-loop bypass on esophagogastric junction function

BackgroundAt present, no objective data are available on the effect of omega-loop gastric bypass (OGB) on gastroesophageal junction and reflux. ObjectivesTo evaluate the possible effects of OGB on esophageal motor function and a possible increase in gastroesophageal reflux. SettingUniversity Hospital, Italy; Public Hospital, Italy. MethodsPatients underwent clinical assessment for reflux symptoms, and endoscopy plus high-resolution impedance manometry (HRiM) and 24-hour pH-impedance monitoring (MII-pH) before and 1 year after OGB. A group of obese patients who underwent sleeve gastrectomy (SG) were included as the control population. ResultsFifteen OGB patients were included in the study. After surgery, none of the patients reported de novo heartburn or regurgitation. At endoscopic follow-up 1 year after surgery, esophagitis was absent in all patients and no biliary gastritis or presence of bile was recorded. Manometric features and patterns did not vary significantly after surgery, whereas intragastric pressures (IGP) and gastroesophageal pressure gradient (GEPG) statistically diminished (from a median of 15 to 9.5, P<.01, and from 10.3 to 6.4, P<.01, respectively) after OGB. In contrast, SG induced a significant elevation in both parameters (from a median of 14.8 to 18.8, P<.01, and from 10.1 to 13.1, P<.01, respectively). A dramatic decrease in the number of reflux events (from a median of 41 to 7; P<.01) was observed after OGB, whereas in patients who underwent SG a significant increase in esophageal acid exposure and number of reflux episodes (from a median of 33 to 53; P<.01) was noted. ConclusionsIn contrast to SG, OGB did not compromise the gastroesophageal junction function and did not increase gastroesophageal reflux, which was explained by the lack of increased IGP and in GEPG as assessed by HRiM.

Helicobacter Pylori Infection in Patients with Chronic Calcular Cholecystitis a Cross- Sectional Study

Aims: Helicobacter pylori was found in the bile and gallbladder, so we are aiming to examine the relationship between H. pylori-like bacteria and chronic calcular cholecystitis. METHODS: This cross-sectional study was conducted at our hospitals from May 2011 to January 2012. One hundred and forty patients with chronic calcular cholecystitis were enrolled in this study. Gastroscopy with gastric or duodenal H.pylori urease test and detection of H. pylori in serum were done before the surgical procedure for all patients. After cholecystectomy, the gallbladder tissue was investigated for H. pylori by rapid urease test and Geimsa stain. RESULTS: Of all 140 patients 62.1 % were females, mean age of our patients was 39.04 ± 7.3 years. H. pylori IgG antibody titre was positive in 32 patients with biliary duodenitis, in 43 patients with biliary gastritis, and in 18 patients with duodenal ulcer. The gastric rapid urease test was positive in 40.7 %. The gallbladder rapid urease test was positive in 25 %. In 24 patients both gastric and gallbladder mucosa tested positive for rapid urease test. In 28 patients, the gastric urease test was positive while the gallbladder mucosa tested negative. In 13 patients, the gallbladder mucosa tested positive while the gastric mucosa was negative. There was a significant correlation between the rapid urease test in the gallbladder and in the gastric or duodenal mucosa (P = 0.002). Modified Geimsa staining of gallbladder specimens revealed that H. pylori-like bacteria were detected in 63.6 %. There was a significant correlation between histopathological examination of gallbladder mucosa stained with Geimsa stain and the gallbladder rapid urease test (P < 0.001), but not correlated with the gastric urease test (P = 0.210). CONCLUSION: Our study demonstrates that H. pylori is present in the gallbladder mucosa in patients with chronic calcular cholecystitis and might be an etiological cause of chronic inflammation`.