Obesity Surgery Center, Department of Emergency-Urgency, General Surgery and Transplantation, University of Bologna, Bologna, Italy.
Obes Surg. 2013 Jan;23(1):131-9. doi: 10.1007/s11695-012-0808-8.
The aims of this study are to evaluate the macroscopic and microscopic changes in the remnant stomach at mid-term follow-up of patients who underwent a Roux-en-Y gastric bypass on vertical banded gastroplasty (RYGB-on-VBG). The stomach could be reached through a 1.1-cm gastro-gastrostomy with an endoscope of standard size.
From January 2009 to July 2010, 51 asymptomatic patients at 4 and 5 years follow-up after RYGB-on-VBG submitted to upper endoscopy. All of them were examined with standard endoscopy with collection of biopsies in gastric fundus, body, and antrum. The macroscopic and microscopic findings were analyzed according to Sydney Classification.
The endoscopy of the remnant stomach was technically easy and already showed on macroscopic examination 90 % cases of gastritis (41.2 % mild, 49 % severe) with tendency of severity in the distal stomach part. Histological analysis detected 39.2 % of active gastritis, 50.6 % of quiescent gastritis, 7.8 % of intestinal metaplasia, and 3.9 % of lymphoma-like gastritis.
The results surprised us. We found a very high rate of mucosa abnormalities after RYGB-on-VBG. All of the patients have to be regularly controlled in follow-up and treatment has to be introduced when needed. Again, we would like to ask the question: what is happening with the remnant stomach after standard RYGB, banded gastric bapass, or minigastric bypass? Did we reach the time to answer the question?
本研究旨在评估在行垂直捆绑胃成形术（RYGB-on-VBG）后的 Roux-en-Y 胃旁路术（RYGB-on-VBG）患者中期随访时残胃的宏观和微观变化。通过标准大小的内镜可以通过 1.1cm 的胃-胃吻合口到达胃。
从 2009 年 1 月到 2010 年 7 月，51 例无症状患者在 RYGB-on-VBG 后 4 至 5 年的随访期间接受了上内窥镜检查。所有患者均接受了标准内镜检查，并在胃底、体和窦部采集活检。根据悉尼分类法分析宏观和微观发现。
残胃内镜技术操作简单，在宏观检查中已经显示 90%的患者存在胃炎（41.2%为轻度，49%为重度），且远端胃部分的严重程度呈趋势性。组织学分析检测到 39.2%的活动性胃炎、50.6%的静止性胃炎、7.8%的肠上皮化生和 3.9%的淋巴瘤样胃炎。
结果令我们感到惊讶。我们发现 RYGB-on-VBG 后黏膜异常的发生率非常高。所有患者都需要在随访中定期接受控制，并且需要在必要时进行治疗。我们再次想问：标准 RYGB、带囊胃旁路术或迷你胃旁路术后残胃会发生什么？我们是否已经到了回答这个问题的时候？
