ElFawal Mohamad Hayssam, Taha Osama, Abdelaal Mahmoud, Mohamad Dyaa, El Haj Ihab I, Tamim Hani, ElFawal Karim, El Ansari Walid
Department of Surgery, Beirut Arab University, Beirut, Lebanon.
Bariatric Unit, Plastic Surgery Department, Assiut University, Assiut, Egypt.
Obes Surg. 2025 Apr;35(4):1273-1284. doi: 10.1007/s11695-025-07700-3. Epub 2025 Mar 14.
The purpose of the current study is to appraise the diagnostic accuracy of upper endoscopy (UE) vs histopathological assessment of patients after one-anastomosis gastric bypass (OAGB), and the presence/absence of symptoms vs these two diagnostic modalities.
Retrospective study of 50 consecutive patients who underwent OAGB during April 2019-April 2020 and consented to participate. Symptoms (symptoms score questionnaire), macroscopic and microscopic data were collected 4 years later to assess distal oesophageal, gastric pouch and anastomotic site changes. Diagnostic accuracies (sensitivity, specificity, positive/negative predictive values) of UE vs biopsy and symptoms vs both were assessed.
Mean age was 48.6 ± 13.3 years; 66% were females. At 4 years, 54% had symptoms (symptom score ≥ 4). There were no dysplasia or cancer among this series. UE abnormalities included non-erosive gastritis (44%) and ulcer/s or erosive gastritis (16% each); histopathology abnormalities included chronic gastritis (80%) and Barrett's oesophagus (14%). For UE compared to biopsy, highest sensitivity (76.5%) was at the level of distal oesophagus and highest specificity (100%) at anastomotic site. Pertaining to symptoms compared to investigative modality, highest sensitivity (81.5%) was in relation to symptoms vs UE, while highest specificity (82.6%) was for symptoms vs biopsy.
It is generally not recommended that (a) UE be used to forecast biopsy abnormalities or lack thereof, except at the anastomotic site, and (b) symptoms or lack thereof be used to forecast the findings of investigative modalities, except with caution, to forecast UE findings in identifying healthy individuals, or to forecast biopsy findings in identifying diseased individuals. Long-term routine follow-up is needed post-OAGB regardless of whether patients are symptomatic or otherwise to rule in or out possible macroscopic/microscopic pathologies. Further research on UE and biopsy findings post-OAGB and their relationships with each other and with symptoms/lack thereof are required to strengthen the thin evidence base.
本研究旨在评估单吻合口胃旁路术（OAGB）后患者上消化道内镜检查（UE）与组织病理学评估的诊断准确性，以及症状的有无与这两种诊断方式之间的关系。
对2019年4月至2020年4月期间连续50例行OAGB且同意参与的患者进行回顾性研究。4年后收集症状（症状评分问卷）、宏观和微观数据，以评估食管远端、胃囊和吻合口部位的变化。评估UE与活检的诊断准确性（敏感性、特异性、阳性/阴性预测值）以及症状与两者的诊断准确性。
平均年龄为48.6±13.3岁；66%为女性。4年后，54%的患者有症状（症状评分≥4）。本系列中未发现发育异常或癌症。UE异常包括非糜烂性胃炎（44%）和溃疡或糜烂性胃炎（各16%）；组织病理学异常包括慢性胃炎（80%）和巴雷特食管（14%）。与活检相比，UE在食管远端的敏感性最高（76.5%），在吻合口部位的特异性最高（100%）。就症状与检查方式而言，症状与UE相比敏感性最高（81.5%），而症状与活检相比特异性最高（82.6%）。
一般不建议：（a）使用UE预测活检异常或无异常，吻合口部位除外；（b）使用症状或无症状预测检查方式的结果，谨慎起见，除外预测UE在识别健康个体中的结果，或预测活检在识别患病个体中的结果。OAGB术后无论患者有无症状都需要进行长期常规随访，以排除或确定可能的宏观/微观病理情况。需要对OAGB术后的UE和活检结果及其相互关系以及与症状/无症状的关系进行进一步研究，以加强薄弱的证据基础。
