Service de Chirurgie Générale, Groupement Hospitalier de l'Ouest Lémanique, Hôpital de Nyon, Chemin de Monastier, Nyon, Switzerland.
Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois, Lausanne, Rue du Bugnon, Lausanne, Switzerland.
J Laparoendosc Adv Surg Tech A. 2020 Aug;30(8):875-878. doi: 10.1089/lap.2020.0094. Epub 2020 Mar 25.
Gastroesophageal reflux disease (GERD) is one of the most important obesity-related comorbidity, with prevalence >50% in obese population. Roux-en-Y gastric bypass (RYGB) is considered the gold standard for metabolic surgery in obese patients with GERD, but in a subgroup of patients this pathological GERD may be not really controlled after this technique. Aims of this article are to discuss surgical and endoscopic options to manage refractory GERD after RYGB. We realized a literature review using the PubMed database and searching articles published before December 2019 about GERD after RYGB. We found six studies, four case reports, and two retrospective studies about surgical and endoscopic options to treat this subgroup of patients. Pharmacological therapy and life style optimization are the first line of treatment. For resistant GERD, new surgical and endoscopic strategies are proposed in the past years to manage this subgroup of patients related to anatomic limitation of RYGB. More studies are needed to compare surgical and endoscopic solutions. The choice of treatment depends on local resources and skills, and if necessary refer the patient to a specialist center.
胃食管反流病（GERD）是肥胖相关的最主要的合并症之一，肥胖人群中的患病率>50%。Roux-en-Y 胃旁路术（RYGB）被认为是肥胖合并 GERD 患者代谢手术的金标准，但在一部分患者中，这种病理性 GERD 在接受该技术后可能仍未得到真正控制。本文的目的是讨论 RYGB 后治疗难治性 GERD 的手术和内镜选择。我们使用 PubMed 数据库进行文献回顾，并搜索了 2019 年 12 月之前发表的关于 RYGB 后 GERD 的文章。我们发现了六篇研究，其中四篇是病例报告，两篇是关于治疗这组患者的手术和内镜选择的回顾性研究。药物治疗和生活方式优化是一线治疗方法。对于难治性 GERD，过去几年提出了新的手术和内镜策略来管理与 RYGB 解剖限制相关的这组患者。需要更多的研究来比较手术和内镜解决方案。治疗的选择取决于当地的资源和技术，如果有必要，将患者转介到专门的中心。
