Bile Reflux is a Common Finding in the Gastric Pouch After One Anastomosis Gastric Bypass

Tuure Saarinen, Kirsi H Pietiläinen, Antti Loimaala, Toni Ihalainen, Henna Sammalkorpi, Anne Penttilä, Anne Juuti, Tuure Saarinen, Kirsi H Pietiläinen, Antti Loimaala, Toni Ihalainen, Henna Sammalkorpi, Anne Penttilä, Anne Juuti

Abstract

Introduction: Data on postoperative bile reflux after one anastomosis gastric bypass (OAGB) is lacking. Bile reflux scintigraphy (BRS) has been shown to be a reliable non-invasive tool to assess bile reflux after OAGB. We set out to study bile reflux after OAGB with BRS and endoscopy in a prospective series (RYSA Trial).

Methods: Forty patients (29 women) underwent OAGB between November 2016 and December 2018. Symptoms were reported and upper gastrointestinal endoscopy (UGE) was done preoperatively. Six months after OAGB, bile reflux was assessed in UGE findings and as tracer activity found in gastric tube and esophagus in BRS (follow-up rate 95%).

Results: Twenty-six patients (68.4%) had no bile reflux in BRS. Twelve patients (31.6%) had bile reflux in the gastric pouch in BRS and one of them (2.6%) had bile reflux also in the esophagus 6 months postoperatively. Mean bile reflux activity in the gastric pouch was 5.2% (1-21%) of total activity. De novo findings suggestive of bile reflux (esophagitis, stomal ulcer, foveolar inflammation of gastric pouch) were found for 15 patients (39.5%) in postoperative UGE. BRS and UGE findings were significantly associated (P = 0.022). Eight patients experienced de novo reflux symptoms at 6 months, that were significantly associated with BRS and de novo UGE findings postoperatively (P = 0.033 and 0.0005, respectively).

Conclusion: Postoperative bile reflux in the gastric pouch after OAGB is a common finding in scintigraphy and endoscopy. The long-term effects of bile exposure will be analyzed in future reports after a longer follow-up.

Trial registration: Clinical Trials Identifier NCT02882685.

Keywords: Bariatric surgery; Bile reflux; One anastomosis gastric bypass; Scintigraphy; Upper gastrointestinal endoscopy.

Conflict of interest statement

The authors declare that they have no other conflict of interest.

Figures

Fig. 1
Fig. 1
Dynamic gamma camera images of bile reflux scintigraphy. Images of a representative patient show bile tracer in the gastric pouch beginning at 51 min after intravenous administration of bile tracer (99mTc-mebrofenin)
Fig. 2
Fig. 2
SPECT–CT scan at the end of bile reflux scintigraphy of a representative patient. Bile tracer activity in the gastric pouch and esophagus are shown
Fig. 3
Fig. 3
Time activity curve of the dynamic series of a bile reflux scintigraphy. Bile tracer activity in the liver (yellow line) and in the gastric pouch (red line) of one representative patient is shown. A subsequent rise in the tracer activity is seen in the gastric tube and in the liver. This is most likely due to reuptake of bile acids through enterohepatic circulation

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Source: PubMed

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