Esophagogastric junction function and gastric pressure profile after minigastric bypass compared with Billroth II

Salvatore Tolone; Mario Musella; Edoardo Savarino; Stefano Cristiano; Ludovico Docimo; Mervyn Deitel

doi:10.1016/j.soard.2019.01.030

Esophagogastric junction function and gastric pressure profile after minigastric bypass compared with Billroth II

Surg Obes Relat Dis. 2019 Apr;15(4):567-574. doi: 10.1016/j.soard.2019.01.030. Epub 2019 Feb 4.

Authors

Salvatore Tolone¹, Mario Musella², Edoardo Savarino³, Stefano Cristiano⁴, Ludovico Docimo⁵, Mervyn Deitel⁶

Affiliations

¹ General and Bariatric Surgery Unit, Department of Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy. Electronic address: salvatore.tolone@unicampania.it.
² Advanced Biomedical sciences Department, Federico II University, Naples, Italy.
³ Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
⁴ Bariatric Surgery Unit, Ospedale del Mare, Naples, Italy.
⁵ General and Bariatric Surgery Unit, Department of Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
⁶ Director of MGB-OAGB Club, Toronto, Canada.

PMID: 30827811
DOI: 10.1016/j.soard.2019.01.030

Abstract

Background: Minigastric bypass (MGB) is being performed widely with effective weight loss and improvement in co-morbidities. Because of similarity to Billroth II (BII), there are concerns about bile reflux.

Objectives: To assess the esophagogastric junction (EGJ) function, esophageal peristalsis, and reflux exposure after MGB and BII.

Setting: University Hospital, Italy; Public Hospital, Italy.

Methods: Obese patients underwent symptom questioning, endoscopy, high-resolution impedance manometry, and impedance-pH monitoring, before and 1 year after MGB. Esophageal motor function, EGJ, EGJ-contractile integral, intragastric pressure (IGP), and gastroesophageal pressure gradient were determined. Acid exposure time, number of refluxes, and symptom-association probability were assessed. A group of patients who underwent BII were studied with the same protocol and served as controls.

Results: Twenty-two MGB and 20 BII patients were studied. After surgery, none of the patients reported de novo heartburn or regurgitation. At endoscopic follow-up, esophagitis and bile findings were absent in all. High-resolution impedance manometry features did not vary significantly after MGB, whereas IGP and gastroesophageal pressure gradient statistically diminished (P < .01). BII patients had significantly lower values in IGP, sphincter pressure, and EGJ-contractile integral. In MGB patients, a marked decrease in number of refluxes (from median 41 to 7, P < .01) was observed, whereas BII patients had statistically significant higher acid exposure and number of refluxes (57, P < .001).

Conclusions: In contrast to BII, MGB does not increase any kind of reflux. Also, the differences in IGP and gastroesophageal pressure gradient suggest that bile reflux occurs more readily after BII than after MGB, and that these 2 operations share more differences than similarities.

Keywords: Bariatric surgery; GERD; High-resolution manometry; Impedance; MGB; MII-pH; Obesity; Reflux.

Publication types

Comparative Study

MeSH terms

Adult
Bile Reflux / epidemiology
Electric Impedance
Esophagogastric Junction / physiology*
Female
Follow-Up Studies
Gastric Bypass* / adverse effects
Gastric Bypass* / methods
Gastric Bypass* / statistics & numerical data
Gastroesophageal Reflux / epidemiology
Heartburn / epidemiology
Humans
Male
Manometry
Middle Aged
Obesity / surgery
Postoperative Complications / epidemiology