Gastric bypass in patients with morbid obesity should be an excellent antireflux procedure.
No acid is produced at the small gastric pouch and no duodenal reflux is present, due to the long Roux-en-Y limb.
Dr Attila Csendes and colleagues evaluated 557 patients with morbid obesity submitted to resectional gastric bypass.
Routine preoperative upper endoscopy with biopsy samples demonstrated 12 patients with Barrett's esophagus and 3 patients with intestinal metaplasia of the cardia.
The researchers repeated an endoscopic procedure twice after surgery.
This produced 7 patients with short-segment Barrett's esophagus, and 5 patients with long-segment Barrett's esophagus.
The research team found that body mass index decreased significantly, from 43 kg/m2 to 29 kg/m2 2 years after surgery.
|Reflux esophagitis symptoms disappeared in all patients 1 year after surgery|
|Journal of Gastrointestinal Surgery|
Symptoms of reflux esophagitis, which were present in 14 of the 15 patients, disappeared in all patients 1 year after surgery.
The researchers observed that preoperative erosive esophagitis and peptic ulcer of the esophagus healed in all patients.
There was regression from intestinal metaplasia to cardiac mucosa in 4 patients with short-segment Barrett's esophagus.
The team found the intestinal metaplasia regressed in one patient with long-segment Barrett's esophagus.
The researchers noted that 2 of 3 cases with intestinal metaplasia of the cardia had regression to cardiac mucosa.
There was no progression to low- or high-grade dysplasia.
Dr Csendes' team concluded, “Gastric bypass in patients with Barrett's esophagus and morbid obesity is an excellent antireflux operation.”
“This has been proven by the disappearance of symptoms and the healing of endoscopic esophagitis or peptic ulcer in all patients, which is followed by an important regression to cardiac mucosa that is length-dependent and time-dependent.”