The Question of Bile Gastro-Esophageal Reflux
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.
KeywordsMini-gastric bypass Mason loop gastric bypass Bile reflux gastritis Barrett’s esophagitis Gastric cancer Esophageal cancer Diagnosis Symptoms Conversion surgery
- 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.CrossRefGoogle Scholar
- 11.Sifrim D. Management of bile reflux. Gastroenterol Hepatol. 2013;9:179–80.Google Scholar
- 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.CrossRefGoogle Scholar
- 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.CrossRefGoogle Scholar