A Systematic Review and Meta-Analysis of the Effect of Roux-en-Y Gastric Bypass on Barrett ’s Esophagus
AbstractBackgroundObesity is associated with a twofold risk of gastroesophageal reflux disease (GERD) and thrice the risk of Barrett ’s esophagus (BE). Roux-en-Y gastric bypass (RYGB) leads to weight loss and improvement of GERD in population with obesity, but its effect on BE is less clear.MethodsBibliographic databases were searched systematically for relevant articles till January 31, 2019. Studies evaluating the effect of RYGB on BE with preoperative and postoperative endoscopy and biopsy were included. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool. Meta-analysis was conducted using Mantel-Haenszel, random effects model and presented as risk difference (RD) or odds ratio (OR) with 95% confidence intervals.ResultsEight studies with 10,779 patients undergoing RYGB reported on 117 patients with BE with follow-up of> 1 year. Significant regression of BE after RYGB was observed (RD − 0.56.95% c.i. − 0.69 to − 0.43;P
AbstractIntroductionSince it was first described in 2001, the one anastomosis gastric bypass (OAGB) has been gaining popularity in the Middle East region and worldwide. We designed a survey to evaluate the trends, techniques, and outcomes of OAGB in our region.MethodsA questionnaire to study OAGB was sent to the members of the IFSO MENA chapter.ResultsOne-hundred and forty-eight surgeons (74%) responded. Forty-six percent of all respondents (64 surgeons) performed OAGB routinely. The most commonly performed procedures were the laparoscopic sleeve gastrostomy (LSG), followed by OAGB, and then Roux-en-Y (RYGB). Of the surgeo...
ConclusionPatients with bile reflux after OAGB/MGB need a high index of suspicion to detect unusual causes. Gastrogastric fistula is an unusual etiology of bile reflux that was never reported in the literature previously.
ConclusionCauses of abdominal pain and GERD after RYGB are difficult to identify. Gastro-gastric fistula is one of them and should be evoked when biliary reflux and abdominal pain appear.
ConclusionsWe recommend LRYGB as an effective combined bariatric and anti-reflux surgical procedure for patients with severe obesity and BE. In short-term follow-up, LRYGB achieved endoscopic and histologic regression to normal mucosa in a substantial number of the patients in our series. Long-term follow-up for patients with BE according to standard surveillance protocols is still recommended.
ConclusionsThe resection of the gastrojejunal anastomosis allows fashioning the Roux-en-Y limb with the classical measures. This technique allows a conversion to a standard RYGB and is effective in treating the biliary reflux.
Sleeve gastrectomy, gastric bypass, gastric banding, and duodenal switch are the most common bariatric procedures performed worldwide. Ninety-five percent of bariatric operations are performed with minimally invasive laparoscopic technique. Perioperative morbidities and mortalities average around 5% and 0.2%, respectively. Long-term weight loss averages around 15% to 25% or about 80 to 100 lbs (40 –50 kg). Comorbidities, including type 2 diabetes, hypertension, dyslipidemia, sleep apnea, arthritis, gastroesophageal reflux disease, and nonalcoholic fatty liver disease, improve or resolve after bariatric surgery.
ConclusionsSalmon ’s technique is an uncommon bariatric procedure. Revisional surgery might be needed in case of late complications, like dysphagia and reflux, as it was the case in our patient. In addition, a fistula in the previous horizontal partitioning of the stomach was present. Laparoscopic conversion from S almon’s technique to a gastric bypass was decided. This procedure was successful in solving patient’s symptoms and resulted in an increased weight lost. Laparoscopic revisional surgery after an open Salmon’s technique is a complex procedure with an increased risk of complications. Our pat...
CONCLUSION: Small HH are over-diagnosed with EGD, as most do not require repair. However, moderate and large HH are accurately detected. PMID: 27639984 [PubMed - as supplied by publisher]
Conclusion A number of techniques can be used to mitigate the severity of reflux, either by maintaining the normal anatomic structures that limit reflux or by supplementing these structures with a plication or gastroplasty. Individuals with existing severe reflux should not be considered for a sleeve gastrectomy. New techniques that incorporate plication at the time of the index sleeve gastrectomy show some improvement, but these are in small series that will need to be further evaluated. The only proven method of treating intractable reflux after sleeve gastrectomy is conversion to a Roux-en-Y gastric bypass.
CONCLUSION Our institution has opted for selective preoperative endoscopy in patients with preoperative gastrointestinal symptoms. In post gastric bypass patients LTHE can be performed with good results.