Tel Aviv Sourasky Medical Center, Bariatric Endoscopy Unit, Department of Gastroenterology and Liver Diseases, Affiliated to Tel Aviv University, Tel Aviv, Israel.
Obes Surg. 2023 Mar;33(3):870-878. doi: 10.1007/s11695-023-06463-z. Epub 2023 Jan 23.
OAGB is the third most common bariatric surgery. Biliary reflux (BR) is an inherent complication of this unique anatomy, although there is still controversy regarding its significance and long-term risks including carcinogenesis. To date, there is no effective treatment for BR with conversion to RYGB reserved for refractory patients. TORe is an effective treatment for weight-regain and dumping syndrome after RYGB. We hypothesized that narrowing the anastomosis would decrease the amount of bile refluxate entering the stomach and esophagus in patients with BR symptoms after OAGB and alleviate symptoms. The purpose of this study is to evaluate the efficacy of TORe for the treatment of BR symptoms after OAGB.
BR was diagnosed clinically in patients after OAGB using the gastroesophageal reflux disease health-related quality of life (GERD-HRQL) instrument after treatment with high-dose proton pump inhibitor (PPI) excluded possible acid reflux. TORe was carried out using a suture pattern that narrowed and elongated the anastomosis. All patients were prospectively followed.
Twelve patients, post-OAGB, underwent TORe for BR. Symptoms resolved in 9 (75%) patients. GERD-HRQL score at 6 months declined from an average of 33.7 (SD 1.9) before the procedure to 16.1 (SD 10, p < 0.001). In one case, a small perforation was identified during the procedure and was immediately sutured with no further sequela.
TORe appears a safe and effective treatment for BR symptoms after OAGB, at least in the short term. Accurate tools for BR diagnosis, a larger cohort, and longer follow-up periods are needed to better show the effectiveness and durability of this treatment option.
OAGB 是第三大常见的减重手术。尽管胆反流（BR）是这种独特解剖结构的固有并发症，但关于其意义和长期风险，包括致癌性，仍存在争议。迄今为止，对于 BR 尚无有效的治疗方法，仅将转换为 RYGB 保留给难治性患者。TORe 是治疗 RYGB 后体重反弹和倾倒综合征的有效方法。我们假设缩小吻合口会减少进入 OAGB 后有 BR 症状患者的胃和食管中的胆汁反流量，并缓解症状。本研究的目的是评估 TORe 治疗 OAGB 后 BR 症状的疗效。
在使用高剂量质子泵抑制剂（PPI）治疗排除可能的酸反流后，使用胃食管反流病健康相关生活质量（GERD-HRQL）工具在 OAGB 后患者中临床诊断 BR。使用缩小和延长吻合口的缝线模式进行 TORe。所有患者均进行前瞻性随访。
12 例 OAGB 后患者接受 TORe 治疗 BR。9 例（75％）患者症状缓解。在手术前，GERD-HRQL 评分平均为 33.7（SD 1.9），术后 6 个月下降至 16.1（SD 10，p<0.001）。在一个病例中，在手术过程中发现一个小穿孔，并立即进行缝合，无进一步后遗症。
TORe 似乎是 OAGB 后 BR 症状的一种安全有效的治疗方法，至少在短期内如此。需要更准确的 BR 诊断工具、更大的队列和更长的随访时间，以更好地展示这种治疗选择的有效性和耐久性。
