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

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  1 , M L Zach  1 , N Vock  1 , J Jedamzik  1 , J Eichelter  1 , M Mairinger  1 , L Gensthaler  1 , L Nixdorf  1 , P Richwien  1 , C Bichler  1 , I Kristo  1 , F B Langer  1 , G Prager  2
Affiliations

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 et al. Surg Endosc. 2023 May.

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.

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Conflict of interest statement

Daniel Moritz Felsenreich received a research grant by EAES (European Association for the Endoscopic Surgery and other interventional techniques). Marie Louise Zach, Natalie Vock, Julia Jedamzik, Jakob Eichelter, Magdalena Mairinger, Lisa Gensthaler, Larissa Nixdorf, Paula Richwien, Christoph Bichler, Ivan Kristo, and Felix Benedikt Langer have no conflicts of interest or financial ties to disclose. Gerhard Prager reports educational grants from Medtronic and Novo Nordisk as well as speakers’ fees by Medtronic.

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