The Question of Bile Gastro-Esophageal Reflux

  • Nasser Sakran


Although it was the main reason to abandon Mason’s loop gastric bypass, the mini-gastric bypass (MGB) anatomical configuration makes esophageal bile reflux highly implausible. However, controversy remains regarding the long-term theoretical risk of subsequent biliary reflux and its possible complications following MGB. According to the current literature, symptomatic gastric and/or esophageal bile reflux and reoperations after MGB due to “intractable” bile reflux are relatively rare.

In addition, cancer arising in the gastric pouch or esophagus has never been reported after specifically MGB, and the only case of cancer reported so far originated in the excluded stomach. However, since gastric/esophageal cancer may appear at least 20 years post-operatively, the fact that it has not been found after MGB may seem to be not enough evidence.

Clear definitions must be made in regard to symptoms, diagnostic approach, and medical treatment of bile reflux after MGB.


Mini-gastric bypass Mason loop gastric bypass Bile reflux gastritis Barrett’s esophagitis Gastric cancer Esophageal cancer Diagnosis Symptoms Conversion surgery 


  1. 1.
    Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg. 2001;11:276–80.CrossRefPubMedGoogle Scholar
  2. 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. Updat Surg. 2011;63:239–42.CrossRefGoogle Scholar
  3. 3.
    Mahawar KK, Carr WR, Balupuri S, Small PK. Controversy surrounding 'mini' gastric bypass. Obes Surg. 2014;24:324–33.CrossRefPubMedGoogle Scholar
  4. 4.
    Georgiadou D, Sergentanis TN, Nixon A, Diamantis T, Tsigris C, Psaltopoulou T. Efficacy and safety of laparoscopic mini gastric bypass. A systematic review. Surg Obes Relat Dis. 2014;10:984–91.CrossRefPubMedGoogle Scholar
  5. 5.
    Mahawar KK, Kumar P, Carr WR, Jennings N, Schroeder N, Balupuri S, Small PK. Current status of mini-gastric bypass. J Minim Access Surg. 2016;12:305–10.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Tolone S, Cristiano S, Savarino E, Lucido FS, Fico DI, Docimo L. Effects of omega-loop bypass on esophagogastric junction function. Surg Obes Relat Dis. 2016;12:62–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Bruzzi M, Chevallier JM, Czernichow S. One-anastomosis gastric bypass: why biliary reflux remains controversial? Obes Surg. 2017;27:545–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Lee WJ, Ser KH, Lee YC, Tsou JJ, Chen SC, Chen JC. Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg. 2012;22:1827–34.CrossRefPubMedGoogle Scholar
  9. 9.
    Wang W, Wei PL, Lee YC, Huang MT, Chiu CC, Lee WJ. Short-term results of laparoscopic mini-gastric bypass. Obes Surg. 2005;15:648–54.CrossRefPubMedGoogle Scholar
  10. 10.
    Richter JE, Pandolfino JE, Vela MF, Kahrilas PJ, Lacy BE, Ganz R, Dengler W, Oelschlager BK, Peters J, DeVault KR, et al. Utilization of wireless pH monitoring technologies: a summary of the proceedings from the esophageal diagnostic working group. Dis Esophagus. 2013;26:755–65.CrossRefPubMedGoogle Scholar
  11. 11.
    Sifrim D. Management of bile reflux. Gastroenterol Hepatol. 2013;9:179–80.Google Scholar
  12. 12.
    Weijenborg PW, Bredenoord AJ. How reflux causes symptoms: reflux perception in gastroesophageal reflux disease. Best Pract Res Clin Gastroenterol. 2013;27:353–64.CrossRefPubMedGoogle Scholar
  13. 13.
    Patrick L. Gastroesophageal reflux disease (GERD): a review of conventional and alternative treatments. Altern Med Rev. 2011;16:116–33.PubMedGoogle Scholar
  14. 14.
    Chen TF, Yadav PK, Wu RJ, Yu WH, Liu CQ, Lin H, Liu ZJ. Comparative evaluation of intragastric bile acids and hepatobiliary scintigraphy in the diagnosis of duodenogastric reflux. World J Gastroenterol. 2013;19(14):2187–96.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Leon E, Jimenez JM, Ortiz-de-Solorzano J, Perez-Miranda M, Castro-Alija MJ. Laparoscopic one-anastomosis gastric bypass: technique, results, and long-term follow-up in 1200 patients. Obes Surg. 2017;27:1153–67.CrossRefGoogle Scholar
  16. 16.
    Khan A, Kim A, Sanossian C, Francois F. Impact of obesity treatment on gastroesophageal reflux disease. World J Gastroenterol. 2016;22:1627–38.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Saarinen T, Rasanen J, Salo J, Loimaala A, Pitkonen M, Leivonen M, Juuti A. Bile reflux scintigraphy after mini-gastric bypass. Obes Surg. 2017;27:2083–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Johnson WH, Fernanadez AZ, Farrell TM, Macdonald KG, Grant JP, McMahon RL, Pryor AD, Wolfe LG, DeMaria EJ. Surgical revision of loop ("mini") gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3:37–41.CrossRefPubMedGoogle Scholar
  19. 19.
    Bruzzi M, Rau C, Voron T, Guenzi M, Berger A, Chevallier JM. Single anastomosis or mini-gastric bypass: long-term results and quality of life after a 5-year follow-up. Surg Obes Relat Dis. 2015;11:321–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Musella M, Susa A, Manno E, De Luca M, Greco F, Raffaelli M, Cristiano S, Milone M, Bianco P, Vilardi A, et al. Complications following the mini/one anastomosis gastric bypass (MGB/OAGB): a multi-institutional survey on 2678 patients with a mid-term (5 years) follow-up. Obes Surg. 2017;27(11):2956–67.CrossRefPubMedGoogle Scholar
  21. 21.
    Chevallier JM, Arman GA, Guenzi M, Rau C, Bruzzi M, Beaupel N, Zinzindohoue F, Berger A. One thousand single anastomosis (omega loop) gastric bypasses to treat morbid obesity in a 7-year period: outcomes show few complications and good efficacy. Obes Surg. 2015;25:951–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Amor IB, Petrucciani N, Kassir R, Al Munifi A, Piche T, Debs T, Gugenheim J. Laparoscopic conversion of one anastomosis gastric b ypass to a standard Roux-en-Y gastric bypass. Obes Surg. 2017;27:1398.CrossRefPubMedGoogle Scholar
  23. 23.
    Salama TMS, Hassan MI. Incidence of biliary reflux esophagitis after laparoscopic omega loop gastric bypass in morbidly obese patients. J Laparoendosc Adv Surg Tech A. 2017;27:618–22.CrossRefPubMedGoogle Scholar
  24. 24.
    Carbajo M, Garcia-Caballero M, Toledano M, Osorio D, Garcia-Lanza C, Carmona JA. One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg. 2005;15:398–404.CrossRefPubMedGoogle Scholar
  25. 25.
    Chakhtoura G, Zinzindohoue F, Ghanem Y, Ruseykin I, Dutranoy JC, Chevallier JM. Primary results of laparoscopic mini-gastric bypass in a French obesity-surgery specialized university hospital. Obes Surg. 2008;18:1130–3.CrossRefPubMedGoogle Scholar
  26. 26.
    Noun R, Skaff J, Riachi E, Daher R, Antoun NA, Nasr M. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg. 2012;22:697–703.CrossRefPubMedGoogle Scholar
  27. 27.
    Musella M, Susa A, Greco F, De Luca M, Manno E, Di Stefano C, Milone M, Bonfanti R, Segato G, Antonino A, et al. The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multicenter review. Surg Endosc. 2014;28:156–63.CrossRefPubMedGoogle Scholar
  28. 28.
    Jammu GS, Sharma R. A 7-year clinical audit of 1107 cases comparing sleeve gastrectomy, Roux-en-Y gastric bypass, and mini-gastric bypass, to determine an effective and safe bariatric and metabolic procedure. Obes Surg. 2016;26:926–32.CrossRefPubMedGoogle Scholar
  29. 29.
    Lessing Y, Pencovich N, Khatib M, Meron-Eldar S, Koriansky J, Abu-Abeid S. One-anastomosis gastric bypass: first 407 patients in 1 year. Obes Surg. 2017;27(10):2583–9. Scholar
  30. 30.
    Lee WJ, Lin YH. Single-anastomosis gastric bypass (SAGB): appraisal of clinical evidence. Obes Surg. 2014;24:1749–56.CrossRefPubMedGoogle Scholar
  31. 31.
    Ito M, Takata S, Tatsugami M, Wada Y, Imagawa S, Matsumoto Y, Takamura A, Kitamura S, Matsuo T, Tanaka S, et al. Clinical prevention of gastric cancer by Helicobacter pylori eradication therapy: a systematic review. J Gastroenterol. 2009;44:365–71.CrossRefPubMedGoogle Scholar
  32. 32.
    Scozzari G, Trapani R, Toppino M, Morino M. Esophagogastric cancer after bariatric surgery: systematic review of the literature. Surg Obes Relat Dis. 2013;9:133–42.CrossRefPubMedGoogle Scholar
  33. 33.
    Wu CC, Lee WJ, Ser KH, Chen JC, Tsou JJ, Chen SC, Kuan WS. Gastric cancer after mini-gastric bypass surgery: a case report and literature review. Asian J Endosc Surg. 2013;6:303–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Deitel M, Hargroder D, Peraglie C. Mini-gastric bypass for bariatric surgery increasing worldwide. Austin J Surg. 2016;3(3):1092–6. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nasser Sakran
    • 1
    • 2
  1. 1.Emek Medical CenterAfulaIsrael
  2. 2.Rappaport Faculty of MedicineTechnion Israel Institute of TechnologyHaifaIsrael

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