Department of Gastrointestinal Surgery, Helsinki University Hospital, Abdominal Center, Helsinki, Finland.
HUS Jorvi Hospital, Turuntie 150, 02740, Espoo, Finland.
Obes Surg. 2020 Mar;30(3):875-881. doi: 10.1007/s11695-019-04353-x.
Data on postoperative bile reflux after one anastomosis gastric bypass (OAGB) is lacking. Bile reflux scintigraphy (BRS) has been shown to be a reliable non-invasive tool to assess bile reflux after OAGB. We set out to study bile reflux after OAGB with BRS and endoscopy in a prospective series (RYSA Trial).
Forty patients (29 women) underwent OAGB between November 2016 and December 2018. Symptoms were reported and upper gastrointestinal endoscopy (UGE) was done preoperatively. Six months after OAGB, bile reflux was assessed in UGE findings and as tracer activity found in gastric tube and esophagus in BRS (follow-up rate 95%).
Twenty-six patients (68.4%) had no bile reflux in BRS. Twelve patients (31.6%) had bile reflux in the gastric pouch in BRS and one of them (2.6%) had bile reflux also in the esophagus 6 months postoperatively. Mean bile reflux activity in the gastric pouch was 5.2% (1-21%) of total activity. De novo findings suggestive of bile reflux (esophagitis, stomal ulcer, foveolar inflammation of gastric pouch) were found for 15 patients (39.5%) in postoperative UGE. BRS and UGE findings were significantly associated (P = 0.022). Eight patients experienced de novo reflux symptoms at 6 months, that were significantly associated with BRS and de novo UGE findings postoperatively (P = 0.033 and 0.0005, respectively).
Postoperative bile reflux in the gastric pouch after OAGB is a common finding in scintigraphy and endoscopy. The long-term effects of bile exposure will be analyzed in future reports after a longer follow-up.
Clinical Trials Identifier NCT02882685.
关于单吻合口胃旁路术后（OAGB）后胆汁反流的数据尚缺乏。胆汁反流闪烁扫描（BRS）已被证明是评估 OAGB 后胆汁反流的一种可靠的非侵入性工具。我们旨在前瞻性系列研究（RYSA 试验）中通过 BRS 和内窥镜检查研究 OAGB 后的胆汁反流。
40 例患者（29 名女性）于 2016 年 11 月至 2018 年 12 月间接受 OAGB。术前报告症状并进行上消化道内窥镜检查（UGE）。OAGB 后 6 个月，通过 UGE 检查结果和 BRS 中胃管和食管中的示踪剂活性评估胆汁反流（随访率 95%）。
26 例患者（68.4%）在 BRS 中无胆汁反流。12 例患者（31.6%）在 BRS 中胃囊中出现胆汁反流，其中 1 例（2.6%）术后 6 个月时食管中也出现胆汁反流。胃囊中平均胆汁反流活性为总活性的 5.2%（1-21%）。术后 UGE 中发现 15 例（39.5%）新出现提示胆汁反流的发现（食管炎、吻合口溃疡、胃囊滤泡性炎症）。BRS 和 UGE 检查结果显著相关（P=0.022）。8 例患者在术后 6 个月时出现新的反流症状，与 BRS 和术后新的 UGE 发现显著相关（P=0.033 和 0.0005）。
OAGB 后胃囊中术后胆汁反流在闪烁扫描和内窥镜检查中是常见发现。在更长的随访后，未来报告将分析胆汁暴露的长期影响。
临床试验标识符 NCT02882685。
