背景:一次吻合术胃旁路术(OAGB)是全球肥胖患者第三大最常见的减肥手术。对OAGB的一个担忧是在中长期随访中存在酸和非酸回流。这项研究的目的是通过比较术前和术后中期结果来客观评估反流和食管运动。
方法:横断面研究;以大学医院为基础。
方法:本研究包括原发性OAGB患者(术前胃镜检查,高分辨率测压(HRM),和阻抗-24小时pH测定)在2017年12月31日之前在维也纳医科大学运营。经过5.1±2.3年的平均随访,这些检查是重复的。此外,体重史,缓解相关医疗问题(AMP),和生活质量(QOL)进行评估。
结果:本研究共纳入21例患者,并进行了所有检查。术前体重为124.4±17.3kg,BMI为44.7±5.6kg/m2,5.1±2.3年后总体重减轻为34.4±8.3%。此外,在这项研究中,AMP和QOL的缓解结果非常令人满意。在胃镜检查中,吻合口炎,食管炎,巴雷特食管,在袋子中发现胆汁:38.1%,28.3%,9.5%,和42.9%。食管下括约肌压力的HRM结果为28.0±15.6mmHg,与术前值相比没有变化。然而,在阻抗-24h-pH-测定法中,酸暴露时间和DeMeester评分显着降低至1.2±1.2%(p=0.004)和7.5±8.9(p=0.017)。Further,返流总数与术前相等;然而,减少的酸回流被非酸回流代替。
结论:这项研究显示,在初级OAGB患者的中期结局后,酸反流率降低,非酸反流增加。胃镜检查显示胃空肠造口术慢性刺激的迹象,小袋,和远端食道,即使是无症状的患者。可以考虑在5年后对OAGB患者进行胃镜检查。
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.
Cross-sectional
study; University-hospital based.
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.
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.
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.