Laparoscopic conversion of omega loop gastric bypass to Roux-en-Y gastric bypass for Barrett’s esophagus: case report

Laparoscopic conversion of omega loop gastric bypass to Roux-en-Y gastric bypass for Barrett’s esophagus: case report

Abstract Background The number of mini gastric bypass / one anastomosis bypass (MGB-OAGB) procedures in bariatric patients that have been performed world-wide has drastically increased during the past decade. Nevertheless, due to the risk of subsequent biliary reflux and development of ulcer and neo...

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Bibliographic Details
Published in:BMC surgery Vol. 22; no. 1; pp. 1 - 273
Main Authors: Lange, U. G, Moulla, Y, Mehdorn, M, Tuennemann, J, Zabel-Langhennig, A, Ouaid, A, Dietrich, A
Format: Journal Article
Language:English
Published: London BioMed Central Ltd 14-07-2022
BioMed Central
BMC
Subjects:
Anastomosis
Barrett's esophagus
Barrett’s metaplasia after MGB-OAGB
Bile
Bile reflux
Biopsy
Body mass
Body mass index
Body size
Cancer
Case Report
Case studies
Classification
Complications
Complications MGB-OAGB
Conversion
Conversion bariatric procedures
Diabetes
Disease
Endoscopy
Epithelium
Esophagitis
Esophagus
Gastric bypass
Gastroesophageal reflux
Gastrointestinal surgery
Gastroscopy
Hiatal hernias
Inflammation
Laparoscopic surgery
Laparoscopy
Magnesium compounds
Malnutrition
Metabolism
Metaplasia
Obesity
Pantoprazole
Patients
Quality
Signs and symptoms
Type 2 diabetes
Weight control
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Summary:Abstract Background The number of mini gastric bypass / one anastomosis bypass (MGB-OAGB) procedures in bariatric patients that have been performed world-wide has drastically increased during the past decade. Nevertheless, due to the risk of subsequent biliary reflux and development of ulcer and neoplastic (pre)lesions caused by long-time bile exposure, the procedure is still controversially discussed. In here presented case report, we could endoscopically demonstrate a transformation from reflux oesophagitis to Barrett’s metaplasia most likely caused by bile reflux after mini-gastric bypass. To our knowledge, this is a first case study that shows development of Barrett’s metaplasia after MGB-OAGB. Case presentation We present the case of a 50-year-old female which received a mini-gastric bypass due to morbid obesity (body mass index (BMI) 42.4 kg/m 2 ). Because of history gastroesophageal reflux disease (GERD), a fundoplication had been performed earlier. Preoperative gastroscopy showed reflux esophagitis (Los Angeles classification grade B) with no signs of Barrett’s metaplasia. Three months post mini-gastric bypass, the patient complained about severe bile reflux under 40 mg pantoprazole daily. Six months postoperative, Endoscopically Barrett’s epithelium was detected and histopathologically confirmed (C1M0 after Prague classification). A conversion into Roux-en-Y gastric bypass was performed. The postoperative course was without complications. In a follow up after 6 months the patient denied reflux and showed no signs of malnutrition. Conclusions The rapid progress from inflammatory changes of the distal esophagus towards Barrett’s metaplasia under bile reflux in our case is most likely a result of previous reflux disease. Nevertheless, bile reflux appears to be a potential decisive factor. Study results regarding presence of bile reflux or development of endoscopically de-novo findings after MGB-OAGB are widely non-conclusive. Long-term prospective studies with regular endoscopic surveillance independent of clinical symptoms are needed.
Bibliography:ObjectType-Case Study-2
SourceType-Scholarly Journals-1
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ISSN:1471-2482
1471-2482
DOI:10.1186/s12893-022-01695-9