Papavramidis S T, Theocharidis A J, Zaraboukas T G, Christoforidou B P, Kessissoglou I I, Aidonopoulos A P
Department of Surgery III, AHEPA Hospital, Aristotelian University of Thessaloniki, 3, St. Kiriakidi Str, Thessaloniki, Macedonia, Greece.
Surg Endosc. 1996 Aug;10(8):825-30. doi: 10.1007/BF00189543.
A total of 30 consecutive morbidly obese patients, six males and 24 females, who underwent vertical banded gastroplasty (VBG) between January 1992 and December 1994 and were followed up by endoscopy and biopsy were included in this study with the aim to determine the short- and mid-term complications and to investigate alterations in esophageal, gastric, and duodenal mucosa after surgery.
All patients underwent endoscopy before operation. Postoperatively, 28 patients were reendoscoped at 6 months, 26 at 12 months, and 22 at 18 months. Biopsies were taken from the lower part of esophagus, just below the esophagogastric junction (vertical part of the partitioned stomach), corpus, antrum, and duodenal bulb.
Before operation 5 patients (16.6%) had a hiatus hernia and four of them (13.3%) had esophagitis. Endoscopic gastritis was diagnosed in nine patients (30%) and endoscopic duodenitis in two (6. 6%). Histologically, in 15 patients (50%) esophagitis was recognized; in 24 patients (80%) corpus gastritis; in 27 patients (90%) antral gastritis; and in 23 (76.6%) duodenitis. Helicobacter pylori was found in 20 (66.6%) patients. Postoperatively, three patients developed a mild stoma stenosis and were treated only by passing the endoscope 6 months after operation; one patient, with a severe stoma stenosis, was treated by Eder-Puestow dilatations and surgery. Gastric ulcer was found in two patients 6 and 12 months after surgery. One patient developed an endostomach channel because of staple line dehiscence 18 months after VBG. An increasing incidence of esophagitis and gastritis of the vertical part of the stomach was found at 6 and 12 months. Endoscopic and histologic gastritis of the corpus and antrum, as well as endoscopic and histologic duodenitis decreased gradually after surgery.
Our findings suggest that postoperative complications of VBG can be diagnosed by endoscopy, and some of them can easily be managed. Vertical banded gastroplasty causes not only no harm to the esophageal, gastric, and duodenal mucosa but also influences them favorably.
本研究纳入了1992年1月至1994年12月期间连续接受垂直束带胃成形术（VBG）的30例病态肥胖患者，其中男性6例，女性24例，术后通过内镜检查和活检进行随访，目的是确定短期和中期并发症，并研究手术后食管、胃和十二指肠黏膜的变化。
所有患者术前均接受内镜检查。术后，28例患者在6个月时接受复查内镜检查，26例在12个月时，22例在18个月时。从食管下部、食管胃交界处下方（分隔胃的垂直部分）、胃体、胃窦和十二指肠球部取活检组织。
术前5例患者（16.6%）有食管裂孔疝，其中4例（13.3%）有食管炎。9例患者（30%）诊断为内镜性胃炎，2例（6.6%）诊断为内镜性十二指肠炎。组织学上，15例患者（50%）有食管炎；24例患者（80%）有胃体胃炎；27例患者（90%）有胃窦胃炎；23例患者（76.6%）有十二指肠炎。20例患者（66.6%）发现幽门螺杆菌。术后，3例患者出现轻度吻合口狭窄，仅在术后6个月通过内镜检查进行治疗；1例患者吻合口严重狭窄，通过Eder-Puestow扩张术和手术治疗。术后6个月和12个月发现2例患者有胃溃疡。1例患者在VBG术后18个月因吻合钉线裂开形成胃内通道。在6个月和12个月时发现胃垂直部分的食管炎和胃炎发病率增加。术后胃体和胃窦的内镜和组织学胃炎以及内镜和组织学十二指肠炎逐渐减少。
我们的研究结果表明，VBG术后并发症可通过内镜诊断，其中一些并发症易于处理。垂直束带胃成形术不仅对食管、胃和十二指肠黏膜无害，而且对其有有利影响。
