PATHOMORPHOLOGICAL ASPECTS OF THE DEVELOPMENT OF BILIARY REFLUX AFTER MINI-GASTRIC BYPASS

INTRODUCTION. MGB is considered to be the best alternative to Roux-en-Y gastric bypass (RYGB) due to the shorter operation time and fewer possible complications. The OBJECTIVE of this study was to determine biliary reflux in patients undergoing MGB with a hand-sewn gastroenteroanastomosis, and MGB with a stapler gastroenteroanastomosis.

MATERIAL AND METHODS. This study included the analysis of results of treatment of 122 patients with morbid obesity and metabolic syndrome who had undergone laparoscopic MGB. Patients were divided into two clinical groups depending on the method of applying gastroenteroanastomosis. Clinical and endoscopic assessment was used to determine bile reflux; biliary reflux index (BRI) was used. In the postoperative period, the possibility of developing biliary reflux using fibrogastroscopy with biopsy of the gastric mucosa, microscopy of biopsy materials was evaluated. Microscopy of biopsy specimens was performed by a pathologist who evaluated each sample of gastric tissue in accordance with the system for determining the biliary reflux index (BRI).

RESULTS. During fibrogastroscopy, biliary reflux was diagnosed in 9 (15.5 %) cases in the study group and 16 (26.6 %) cases in the control group. In the study group of patients, biliary reflux index (BRI) > 14 was determined in 3 patients (5.153 %). In the control group of patients, BRI> 14 was in 7 cases (10.94 %). The difference was significant (p<0.05).

CONCLUSION. Determination of BRI index in patients undergoing MGB could be used as a screening method for diagnosing the biliary reflux in order to prevent and develop the tactic for further management of patients from a risk group of complications associated with the toxic effects of an aggressive bile refluxate.

The authors declare no conflict of interest.

The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

1. Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg. 2001;11(2):76–80.

2. Piazza L., Ferrara F., Leanza S., Coco D., Sarva S., Bellia A., Di Stefano C., Basile F., Biondi A. Laparoscopic mini-gastric bypass: short-term single-institute experience. Updates Surg. 2011;63(2):39–42.

3. Mahawar K. K., Carr W. R., Balupuri S., Small P. K. Controversy surrounding ‘mini’ gastric bypass. Obes Surg. 2014;24(3):24–33.

4. Georgiadou D., Sergentanis T. N., Nixon A., Diamantis T., Tsigris C., Psaltopoulou T. Efficacy and safety of laparoscopic mini gastric bypass. A systematic review. Surg Obes Relat Dis. 2014;10(9):84–91.

5. Mahawar K. K., Kumar P., Carr W. R., Jennings N., Schroeder N., Balupuri S., Small P. K. Current status of mini-gastric bypass. J Minim Access Surg. 2016;12(30):305–310.

6. Khitaryan A. G., Starzhinskaya O. B., Mezhunc A. V., Veliev K. S., Zavgorodnyaya R. N., Orekhov A. A. Gastroezofageal’naya reflyuksnaya bolezn’ u pacientov s ozhireniem raznoj stepeni tyazhesti i saharnym diabetom. Tavricheskij mediko-biologicheskij vestnik. 2018:21(3):129–137. (In Russ.).

7. Salama T. M. S., Hassan M. I. Incidence of biliary reflux esophagitis after laparoscopic omega loop gastric bypass in morbidly obese patients. J Laparoendosc Adv Surg Tech A. 2017;27(6):18–22.

8. Saarinen T., Rasanen J., Salo J., Loimaala A., Pitkonen M., Leivonen M., Juuti A. Bile reflux scintigraphy after mini-gastric bypass. Obes Surg. 2017;27(208):2083–2089.

9. Bruzzi M., Chevallier J. M., Czernichow S. One-anastomosis gastric bypass: why biliary reflux remains controversial? Obes Surg. 2017;27(54):545–547.

10. Tolone S., Cristiano S., Savarino E., Lucido F. S., Fico D. I., Docimo L. Effects of omega-loop bypass on esophagogastric junction function. Surg Obes Relat Dis. 2016;12(6):62–69.

11. Aprea G., Canfora A., Ferronetti A. Morpho-functional gastric pre-and post-operative changes in elderly patients undergoing laparoscopic cholecystectomy for gallstone related disease. BMC Surg. 2012;12(1):5. Doi: 10.1186/1471-2482-12-S1-S5.

12. Kuran S., Parlak E., Aydog G. Bile reflux index after therapeutic biliary procedures. BMC Gastroenterol. 2008;8:4–11. Doi: 10.1186/1471- 230x-8-4.

13. Dedov I. I., Mel’nichenko G. A., Shestakova M. V. et al. Nacional’nye klinicheskie rekomendacii po lecheniyu morbidnogo ozhireniya u vzroslyh. 3-ij peresmotr (Lechenie morbidnogo ozhireniya u vzroslyh). Obesity and metabolism. 2018;15(1):53–70. Doi: 10.14341/OMET2018153-70. (In Russ.).

14. Zaslavskij A. Yu., Kuprinenko N. V. Konspekt endokrinologa. Ch. 4. Lechenie ozhireniya u vzroslyh. Evropejskie klinicheskie rekomendacii (2008). 2011:32. (In Russ.).

15. Schafer L. W., Larson D. E., Melton L. J. The risk of gastric carcinoma after surgical treatment for benign ulcer disease: a population-based study in Olmsted County. MN N Engl J Med. 1983;309(121):1210–1213.

16. Clark C. G., Fresni A., Gledhill T. Cancer following gastric surgery. Br J Surg. 1985;72(8)(59):591–594.

17. Luukkonen P., Kalima T., Kivilaako E. Decreased risk of gastric stump carcinoma after partial gastrectomy. Hepatogastroenterology. 1990;37(39):392–396.

18. Bassily R., Smallwood R. A., Crotty R. Risk of gastric cancer is not increased after partial gastrectomy. J Gastroenterol Hepatol. 2000;15(7) (76):762–767.

19. Scozzari G., Trapani R., Toppino M., Morino M. Esophagogastric cancer after bariatric surgery: systematic review of the literature. Surg Obes Relat Dis. 2013;9(1)(1):133–142.

20. Nau P., Rattner D. W., Meireles O. Linitus plastica presenting two years after elective Roux-en-Y gastric bypass for treatment of morbid obesity: a case report and review of the literature. Surg Obes Relat Dis. 2014;10(2) (1):15–17. Doi: 10.1016/j.soard.2013.06.015.

21. Scheepers A. F., Schoon E. J., Nienhuijs S. W. Esophageal cancer after sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(4)(1):11–12. Doi: 10.1016/j.soard.2010.09.019.

22. Angrisani L., Santonicola A., Iovino P. Gastric cancer: a de novo diagnosis after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014;10(1)(18):186–187. Doi: 10.1016/j.soard.2013.09.009.

23. Champion G., Richter J. E.,Vaezi M. F. et al. Duodenogastroesophageal reflux: relationship to pH and importance in Barrett’s esophagus. Gastroenterol. 1994;107(7):47–54.

24. Sifrim D., Castell D., Dent J. et al. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut. 2004;53(10):24–31.

25. Sposob khirurgicheskogo lecheniya morbidnogo ozhireniya: patent № 2016134082 Ros. Federatsiya. Mezhuts A. V., Khitaryan A. G., Zavgorodnyaya R. N. et al.; zayavl. 19.08.2016; оpubl. 11.01.2018, Byul. № 2. (In Russ.).

26. Yanul’ A. N., Lyubutina G. P. Sistema OLGA-2008: sovremennaya Mezhdunarodnaya gistologicheskaya klassifikaciya hronicheskih gastritov. Voennaya medicina. 2011;(3):32–35. (In Russ.).