Tolone Salvatore, Cristiano Stefano, Savarino Edoardo, Lucido Francesco Saverio, Fico Domenico Ivan, Docimo Ludovico
Division of General and Bariatric Surgery, Department of Surgery, Second University of Naples, Naples, Italy.
General and Bariatric Surgery Unit, Camilliani Hospital, Casoria, Italy.
Surg Obes Relat Dis. 2016 Jan;12(1):62-9. doi: 10.1016/j.soard.2015.03.011. Epub 2015 Mar 27.
At present, no objective data are available on the effect of omega-loop gastric bypass (OGB) on gastroesophageal junction and reflux.
To evaluate the possible effects of OGB on esophageal motor function and a possible increase in gastroesophageal reflux.
University Hospital, Italy; Public Hospital, Italy.
Patients 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.
Fifteen 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.
In 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.
目前，关于ω-袢胃旁路术（OGB）对胃食管交界处及反流的影响，尚无客观数据。
评估OGB对食管运动功能的可能影响以及胃食管反流可能的增加情况。
意大利大学医院；意大利公立医院。
患者在OGB术前及术后1年接受反流症状的临床评估、内镜检查加高分辨率阻抗测压法（HRiM）以及24小时pH-阻抗监测（MII-pH）。一组接受袖状胃切除术（SG）的肥胖患者作为对照人群。
15例OGB患者纳入研究。术后，无一例患者报告新发烧心或反流。术后1年的内镜随访中，所有患者均无食管炎，未记录到胆汁性胃炎或胆汁存在。测压特征和模式术后无显著变化，而OGB术后胃内压（IGP）和胃食管压力梯度（GEPG）在统计学上有所降低（分别从中位数15降至9.5，P<0.01，以及从10.3降至6.4，P<0.01）。相比之下，SG导致这两个参数均显著升高（分别从中位数14.8升至18.8，P<0.01，以及从10.1升至13.1，P<0.01）。OGB术后观察到反流事件数量显著减少（从中位数41降至7；P<0.01），而接受SG的患者食管酸暴露和反流发作次数显著增加（从中位数33增至53；P<0.01）。
与SG不同，OGB未损害胃食管交界处功能，也未增加胃食管反流，这可通过HRiM评估的IGP和GEPG未增加来解释。
