Clinic for Visceral, Transplant and Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
Division of Gastroenterology, Department of Internal Medicine, Neurology and Dermatology, University Hospital of Leipzig, Leipzig, Germany.
BMC Surg. 2022 Jul 14;22(1):273. doi: 10.1186/s12893-022-01695-9.
The number of mini gastric bypass / one anastomosis bypass (MGB-OAGB) procedures in bariatric patients that have been performed world-wide has drastically increased during the past decade. Nevertheless, due to the risk of subsequent biliary reflux and development of ulcer and neoplastic (pre)lesions caused by long-time bile exposure, the procedure is still controversially discussed. In here presented case report, we could endoscopically demonstrate a transformation from reflux oesophagitis to Barrett's metaplasia most likely caused by bile reflux after mini-gastric bypass. To our knowledge, this is a first case study that shows development of Barrett's metaplasia after MGB-OAGB.
We present the case of a 50-year-old female which received a mini-gastric bypass due to morbid obesity (body mass index (BMI) 42.4 kg/m). Because of history gastroesophageal reflux disease (GERD), a fundoplication had been performed earlier. Preoperative gastroscopy showed reflux esophagitis (Los Angeles classification grade B) with no signs of Barrett's metaplasia. Three months post mini-gastric bypass, the patient complained about severe bile reflux under 40 mg pantoprazole daily. Six months postoperative, Endoscopically Barrett's epithelium was detected and histopathologically confirmed (C1M0 after Prague classification). A conversion into Roux-en-Y gastric bypass was performed. The postoperative course was without complications. In a follow up after 6 months the patient denied reflux and showed no signs of malnutrition.
The rapid progress from inflammatory changes of the distal esophagus towards Barrett's metaplasia under bile reflux in our case is most likely a result of previous reflux disease. Nevertheless, bile reflux appears to be a potential decisive factor. Study results regarding presence of bile reflux or development of endoscopically de-novo findings after MGB-OAGB are widely non-conclusive. Long-term prospective studies with regular endoscopic surveillance independent of clinical symptoms are needed.
在过去的十年中，全球范围内进行的减重患者迷你胃旁路/单吻合口旁路（MGB-OAGB）手术数量急剧增加。然而，由于长时间胆汁暴露导致随后发生的胆汁反流以及溃疡和肿瘤（前）病变的风险，该手术仍存在争议。在本案例报告中，我们可以通过内镜证明迷你胃旁路手术后由胆汁反流引起的反流性食管炎向 Barrett 化生的转变。据我们所知，这是首例显示 MGB-OAGB 后发生 Barrett 化生的病例研究。
我们介绍了一位 50 岁女性的病例，因病态肥胖（体重指数（BMI）42.4kg/m）接受了迷你胃旁路手术。由于有胃食管反流病（GERD）病史，之前进行了胃底折叠术。术前胃镜检查显示反流性食管炎（洛杉矶分类 B 级），无 Barrett 化生迹象。迷你胃旁路手术后 3 个月，患者每天抱怨严重的胆汁反流，需要 40mg 泮托拉唑治疗。术后 6 个月，内镜下发现 Barrett 上皮并经组织病理学证实（布拉格分类后 C1M0）。随后进行了 Roux-en-Y 胃旁路手术。术后过程无并发症。在 6 个月的随访中，患者否认有反流症状，且没有出现营养不良迹象。
在我们的病例中，由于先前的反流性疾病，远端食管的炎症性变化迅速向 Barrett 化生发展，这很可能是胆汁反流的结果。然而，胆汁反流似乎是一个潜在的决定性因素。关于 MGB-OAGB 后存在胆汁反流或内镜下新发现的发展的研究结果广泛不一致。需要进行长期前瞻性研究，定期进行内镜监测，独立于临床症状。
