Castagneto-Gissey Lidia, Gualtieri Loredana, Diddoro Annalisa, Lauro Augusto, Genco Alfredo, Casella Giovanni
Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
Dig Dis Sci. 2023 May;68(5):1698-1704. doi: 10.1007/s10620-023-07874-9. Epub 2023 Feb 28.
Esophageal lesions ranging from erosive esophagitis to Barrett's esophagus (BE) eventually develop months-years after sleeve gastrectomy (SG), representing a significant post-surgical issue in GI practice. Roux-en-Y gastric bypass (RYGB) conversion is a widespread and effective method of managing reflux and esophageal complications following SG. Although some studies using a limited sample size have demonstrated that RYGB performed as a primary procedure may regress BE presumably by reducing reflux, whether the same may apply to RYGB performed as revision surgery after SG has scarcely been addressed in the literature. Though histological regression of BE following primary RYGB occurs in 51.9% of patients, with regression of Barrett's dysplasia in 50% of cases, revisional RYGB yields a remission rate as high as 81.8% for Barrett's metaplasia and 100% for dysplastic lesions, although the number of subjects in the published studies are very small. We report two patients who developed GERD and BE following SG with complete regression 12 months after conversion to RYGB in both subjects, confirming the substantially greater proportion of BE resolution in patients undergoing RYGB as revision surgery following SG.
食管病变，从糜烂性食管炎到巴雷特食管（BE），最终在袖状胃切除术（SG）数月至数年之后出现，这是胃肠病学实践中一个重大的术后问题。Roux-en-Y胃旁路术（RYGB）转换术是处理SG术后反流和食管并发症的一种广泛应用且有效的方法。尽管一些样本量有限的研究表明，作为初次手术的RYGB可能通过减少反流使BE消退，但对于SG术后作为翻修手术的RYGB是否同样适用，文献中几乎未涉及。虽然初次RYGB术后51.9%的患者BE出现组织学消退，50%的病例巴雷特发育异常消退，但翻修性RYGB对巴雷特化生的缓解率高达81.8%，对发育异常病变的缓解率为100%（尽管已发表研究中的受试者数量非常少）。我们报告了2例SG术后发生胃食管反流病（GERD）和BE的患者，2例患者在转换为RYGB术后12个月均完全消退，证实了SG术后接受RYGB翻修手术的患者中BE消退比例显著更高。
