Saarinen Tuure, Räsänen Jari, Salo Jarmo, Loimaala Antti, Pitkonen Miia, Leivonen Marja, Juuti Anne
Department of Abdominal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00029, Helsinki, HUS, Finland.
Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Obes Surg. 2017 Aug;27(8):2083-2089. doi: 10.1007/s11695-017-2608-7.
Significant weight-loss and diabetes remission have been reported after mini-gastric bypass (MGB). Concern has been raised regarding postoperative bile reflux (BR), but it has not been demonstrated in previous studies. We set out to find out if BR is evident in hepatobiliary scintigraphy after MGB.
Nine consecutive patients, seven with type 2 diabetes, underwent MGB (15 cm gastric tube, 250-275 cm biliary limb) at our institution with a 12-month follow-up, with none lost to follow-up. Then, 10.7 months (8.6-13.0) after MGB, all patients underwent hepatobiliary scintigraphy and a reflux symptom questionnaire (GerdQ) was filled out. A gastroscopy with biopsies was done for all patients with a bile-reflux-positive scintigraphy.
Mean age at operation was 56 years (41-65) and preoperative BMI 43.1 kg/m (34.2-54.6). Mean %EWL was 83.9 (49.5-128.3) at 12 months. Four patients reached diabetes remission and two became insulin-independent. Hepatobiliary scintigraphy showed a transient BR into the gastric tube for five patients. Bile tracer was found in the gastric tube at 23-58 min after the tracer injection and highest activity was 8% (1-8%) at 58 min. Bile tracer was not found in the esophagus of any of the patients. One patient with a positive scintigraphy in the gastric tube required re-operation. Two patients with reflux symptoms had a negative scintigraphy.
Our results indicate that transient bile reflux is common after MGB in the gastric tube, but not in the esophagus. The clinical relevance of bile reflux needs further studies.
小型胃旁路术（MGB）后有显著体重减轻和糖尿病缓解的报道。术后胆汁反流（BR）引发了关注，但此前研究尚未证实这一点。我们旨在探究MGB后肝胆闪烁显像中BR是否明显。
9例连续患者，其中7例为2型糖尿病患者，在我们机构接受了MGB（胃管15 cm，胆肠袢250 - 275 cm），并进行了12个月的随访，无失访病例。然后，在MGB后10.7个月（8.6 - 13.0个月），所有患者接受了肝胆闪烁显像，并填写了反流症状问卷（GerdQ）。对所有闪烁显像胆汁反流阳性的患者进行了胃镜检查及活检。
手术时平均年龄为56岁（41 - 65岁），术前体重指数为43.1 kg/m²（34.2 - 54.6）。12个月时平均%EWL为83.9（49.5 - 128.3）。4例患者实现糖尿病缓解，2例不再依赖胰岛素。肝胆闪烁显像显示5例患者胃管内有短暂的胆汁反流。注射示踪剂后23 - 58分钟在胃管内发现胆汁示踪剂，58分钟时最高活性为8%（1 - 8%）。所有患者食管内均未发现胆汁示踪剂。1例胃管闪烁显像阳性的患者需要再次手术。2例有反流症状的患者闪烁显像为阴性。
我们的结果表明，MGB后胃管内短暂胆汁反流常见，但食管内不常见。胆汁反流的临床相关性需要进一步研究。
