一吻合胃旁路手术后胃黏膜的病理及免疫组化分析。

Pathological and immunohistochemical analysis of gastric mucosa after one anastomosis gastric bypass surgery.

机构信息

Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.

Bariatric/Metabolic Surgical Center, Ben Q Hospital, Suzhou, China.

出版信息

Asian J Endosc Surg. 2024 Jul;17(3):e13324. doi: 10.1111/ases.13324.

DOI:10.1111/ases.13324

PMID:38804100

Abstract

BACKGROUND

One anastomosis gastric bypass (OAGB) is now the third most common bariatric surgery worldwide. This procedure is garnering increasing attention, but its complication of bile reflux and the associated risk of gastric carcinogenesis remains controversial.

OBJECTIVE

The study aims to assess the impact of bile reflux on the gastric mucosa by comparing pathological and immunohistochemical results of gastric mucosa before and 2 years after OAGB surgery.

METHODS

This retrospective study analyzed gastric lesions observed in gastroscopy before and after OAGB surgery. Pathological examinations were conducted on mucosal samples from proximal, middle and distal part of stomach, with a particular focus on the expression of Ki-67, P53, and CDX2 in immunohistochemistry. Ki-67 indicates cellular proliferation, P53 is a tumor suppressor protein, and CDX2 is a marker for intestinal differentiation.

RESULTS

A total of 16 patients completed the follow-up. Regarding gastritis, presurgery nonerosive gastritis was found in two cases (12.5%), and postsurgery in six cases (37.5%). Erosive gastritis increased from one case (6.2%) presurgery to three cases (18.7%) postsurgery, totaling an increase from three to nine cases (p = .028). Bile reflux in the stomach increased from one case (6.2%) presurgery to three cases (18.7%) postsurgery. Most lesions in the proximal, middle, and distal part of stomach were relatively mild, with normal tissue states being predominant. Mild inflammation was found in all three areas, whereas moderate inflammation, intestinal metaplasia, and glandular atrophy were less common. No cases of severe inflammation were noted. The expression of gastric biomarkers CDX-2, Ki67, and P53 showed no significant statistical variation in different areas.

CONCLUSION

Bile reflux does occur after OAGB, but its incidence is not high. Based on the immunohistochemical and pathological results of the gastric mucosa 2 years post-OAGB, there seems to be no significant causal relationship between OAGB and oncogenic inflammation around the gastric tube.

摘要

背景

单吻合胃旁路术（OAGB）现已成为全球第三大常见的减重手术。这种手术越来越受到关注，但它引起的胆汁反流及其相关的胃癌发生风险仍存在争议。

目的

本研究旨在通过比较 OAGB 手术后 2 年前后胃黏膜的病理和免疫组织化学结果，评估胆汁反流对胃黏膜的影响。

方法

本回顾性研究分析了 OAGB 手术后胃内镜检查中观察到的胃病变。对胃近端、胃中部和胃远端的黏膜样本进行了病理检查，特别关注免疫组织化学中 Ki-67、P53 和 CDX2 的表达。Ki-67 表示细胞增殖，P53 是一种肿瘤抑制蛋白，CDX2 是肠分化的标志物。

结果

共有 16 例患者完成了随访。关于胃炎，术前非糜烂性胃炎 2 例（12.5%），术后 6 例（37.5%）。术前 1 例（6.2%）侵蚀性胃炎增加到术后 3 例（18.7%），共 3 例增加到 9 例（p=0.028）。胃内胆汁反流从术前 1 例（6.2%）增加到术后 3 例（18.7%）。胃近端、胃中部和胃远端的大多数病变相对较轻，以正常组织状态为主。所有三个区域均发现轻度炎症，而中度炎症、肠上皮化生和腺体萎缩则不太常见。未见严重炎症病例。胃标志物 CDX-2、Ki67 和 P53 的表达在不同区域均无显著统计学差异。