Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brasil.
Unit of Digestive Endoscopy, State University of Campinas (UNICAMP), Campinas, Brazil.
Surg Endosc. 2023 May;37(5):3720-3727. doi: 10.1007/s00464-023-09884-0. Epub 2023 Jan 17.
There is much debate over the occurrence of biliary reflux to the gastric pouch after one anastomosis gastric bypass (OAGB) and its potential risks.
To assess endoscopic and histopathological findings following a standardized protocol of biopsy collection two years after OAGB.
A historical cohort study was conducted, based on a prospectively collected database, which involved 39 participants who underwent OAGB. Participants underwent clinical evaluation and esophagogastroduodenoscopy at the time of surgery and 24 months afterward. Post-operatively, biopsy specimens in esophagogastric junction, pouch, and anastomosis were systematically collected.
92.3% of the participants were female and the mean age was 37 ± 8.5 years. The mean body mass index (BMI) significantly decreased from 37.6 ± 5.7 kg/m to 27 ± 4.1 kg/m after 2 years (p < 0.001). The mean %TWL was 27.2 ± 10.5%. The prevalence of non-erosive gastritis significantly increased from 25.6 to 51.3% (p = 0.02). Erosive gastritis significantly decreased from 28.2 to 10.3% (p = 0.04). Four cases of marginal ulcers were identified (10.3%). The commonest histopathological finding was mild inflammation in 74.3% (esophagogastric junction), 58.9% (pouch), and 71.8% (anastomosis). There was one case of focal intestinal metaplasia in each site of interest and no cases of dysplasia or severe inflammation.
Using a standardized protocol of post-operative biopsy collection, low rates of severe endoscopic and histopathological abnormalities were observed two years after OAGB. Nevertheless, as most patients have histologically proven inflammation, bile in the gastric pouch, and endoscopic gastritis, long-term surveillance is essential because of the uncertain risk of these abnormalities.
关于单吻合口胃旁路术后（OAGB）胆液反流至胃袋及其潜在风险，存在诸多争议。
通过 OAGB 术后两年标准化活检采集方案，评估内镜和组织病理学发现。
本研究基于前瞻性数据库进行了一项历史性队列研究，共纳入 39 名接受 OAGB 术的患者。患者在手术时和术后 24 个月进行临床评估和食管胃十二指肠镜检查。术后，系统采集食管胃结合部、胃袋和吻合口的活检标本。
92.3%的参与者为女性，平均年龄为 37±8.5 岁。术后 2 年，平均体重指数（BMI）从 37.6±5.7 kg/m 显著下降至 27±4.1 kg/m（p<0.001）。平均%TWEL 为 27.2±10.5%。非侵蚀性胃炎的患病率从 25.6%显著上升至 51.3%（p=0.02）。侵蚀性胃炎的患病率从 28.2%显著下降至 10.3%（p=0.04）。发现 4 例边缘性溃疡（10.3%）。最常见的组织病理学发现是 74.3%（食管胃结合部）、58.9%（胃袋）和 71.8%（吻合口）的轻度炎症。每个感兴趣部位均有 1 例局灶性肠上皮化生，无发育不良或严重炎症病例。
通过 OAGB 术后标准化活检采集方案，术后两年观察到严重内镜和组织病理学异常的发生率较低。然而，由于这些异常的风险不确定，大多数患者存在组织学证实的炎症、胃袋中的胆汁和内镜下胃炎，因此需要长期监测。
