Esophageal function and non-acid reflux evaluated by impedance-24 h-pH-metry, high-resolution manometry, and gastroscopy after one-anastomosis gastric bypass-outcomes of a prospective mid-term study

D M Felsenreich; M L Zach; N Vock; J Jedamzik; J Eichelter; M Mairinger; L Gensthaler; L Nixdorf; P Richwien; C Bichler; I Kristo; F B Langer; G Prager

doi:10.1007/s00464-022-09857-9

Esophageal function and non-acid reflux evaluated by impedance-24 h-pH-metry, high-resolution manometry, and gastroscopy after one-anastomosis gastric bypass-outcomes of a prospective mid-term study

Surg Endosc. 2023 May;37(5):3832-3841. doi: 10.1007/s00464-022-09857-9. Epub 2023 Jan 24.

Authors

D M Felsenreich¹, M L Zach¹, N Vock¹, J Jedamzik¹, J Eichelter¹, M Mairinger¹, L Gensthaler¹, L Nixdorf¹, P Richwien¹, C Bichler¹, I Kristo¹, F B Langer¹, G Prager²

Affiliations

¹ Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
² Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria. gerhard.prager@meduniwien.ac.at.

Abstract

Background: One-Anastomosis Gastric Bypass (OAGB) is the third most common bariatric operation for patients with obesity worldwide. One concern about OAGB is the presence of acid and non-acid reflux in a mid- and long-term follow-up. The aim of this study was to objectively evaluate reflux and esophagus motility by comparing preoperative and postoperative mid-term outcomes.

Setting: Cross-sectional study; University-hospital based.

Methods: This study includes primary OAGB patients (preoperative gastroscopy, high-resolution manometry (HRM), and impedance-24 h-pH-metry) operated at Medical University of Vienna before 31st December 2017. After a mean follow-up of 5.1 ± 2.3 years, these examinations were repeated. In addition, history of weight, remission of associated medical problems (AMP), and quality of life (QOL) were evaluated.

Results: A total of 21 patients were included in this study and went through all examinations. Preoperative weight was 124.4 ± 17.3 kg with a BMI of 44.7 ± 5.6 kg/m², total weight loss after 5.1 ± 2.3 years was 34.4 ± 8.3%. In addition, remission of AMP and QOL outcomes were very satisfactory in this study. In gastroscopy, anastomositis, esophagitis, Barrett´s esophagus, and bile in the pouch were found in: 38.1%, 28.3%, 9.5%, and 42.9%. Results of HRM of the lower esophageal sphincter pressure were 28.0 ± 15.6 mmHg, which are unchanged compared to preoperative values. Nevertheless, in the impedance-24 h-pH-metry, acid exposure time and DeMeester score decreased significantly to 1.2 ± 1.2% (p = 0.004) and 7.5 ± 8.9 (p = 0.017). Further, the total number of refluxes were equal to preoperative; however, the decreased acid refluxes were replaced by non-acid refluxes.

Conclusion: This study has shown decreased rates of acid reflux and increased non-acid reflux after a mid-term outcome of primary OAGB patients. Gastroscopy showed signs of chronic irritation of the gastrojejunostomy, pouch, and distal esophagus, even in asymptomatic patients. Follow-up gastroscopies in OAGB patients after 5 years may be considered.

Keywords: Gastroscopy; High-resolution manometry; Impedance-24 h-pH-metry; Non-acid reflux; One-Anastomosis Gastric Bypass; Quality of life.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Electric Impedance
Gastric Bypass* / methods
Gastroesophageal Reflux* / diagnosis
Gastroesophageal Reflux* / etiology
Gastroesophageal Reflux* / surgery
Gastroscopy
Humans
Hydrogen-Ion Concentration
Manometry
Obesity, Morbid* / surgery
Prospective Studies
Quality of Life