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Biliary Reflux

The Experts below are selected from a list of 249 Experts worldwide ranked by ideXlab platform

Arnaud Liagre – 1st expert on this subject based on the ideXlab platform

  • Conversion of One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) for Biliary Reflux Resistant to Medical Treatment: Lessons Learned from a Retrospective Series of 2780 Consecutive Patients Undergoing OAGB
    Obesity Surgery, 2020
    Co-Authors: Radwan Kassir, Niccolo Petrucciani, Tarek Debs, Gildas Juglard, Francesco Martini, Arnaud Liagre

    Abstract:

    Background Biliary Reflux resistant to medical treatment has an incidence of 0.6–10% after one anastomosis gastric bypass (OAGB) and may be a reason for revisional surgery. The aim of this study is to report the results of a single-institution series of patients who underwent conversion from OAGB to Roux-en-Y gastric bypass (RYGB) for Biliary Reflux. Methods Data of OAGB patients converted to RYGB between May 2010 and December 2017 were prospectively collected and retrospectively analyzed. The afferent limb was sectioned proximally to the gastrojejunal anastomosis. A jejuno-jejunal latero-lateral anastomosis was performed between the Biliary and alimentary limb. The final RYGB had an alimentary limb of 100 cm and a Biliary limb of 150 cm. Results During the study period, 2780 patients underwent OAGB. A total of 32 patients (1.2%) underwent conversion from OAGB to RYGB for Biliary Reflux, at a mean of 30.3 months from OAGB. Mean weight before RYGB was 70.6 kg, and mean body mass index BMI was 26 kg/m^2. Four patients experienced postoperative complications (12.5%). Patients’ mean weight was 74.3 kg at 24 months follow-up, with BMI of 27.2 kg/m^2. Conversion to RYGB relieved symptoms of Biliary Reflux in all patients but 2 (93.8%). Conclusions Biliary Reflux although rare can complicate OAGB. RYGB is a safe and feasible technique of revision in this case. A shorter length of the afferent limb during the initial operation facilitates the revision.

  • conversion of one anastomosis gastric bypass oagb to roux en y gastric bypass rygb for Biliary Reflux resistant to medical treatment lessons learned from a retrospective series of 2780 consecutive patients undergoing oagb
    Obesity Surgery, 2020
    Co-Authors: Radwan Kassir, Niccolo Petrucciani, Tarek Debs, Gildas Juglard, Francesco Martini, Arnaud Liagre

    Abstract:

    BACKGROUND: Biliary Reflux resistant to medical treatment has an incidence of 0.6-10% after one anastomosis gastric bypass (OAGB) and may be a reason for revisional surgery. The aim of this study is to report the results of a single-institution series of patients who underwent conversion from OAGB to Roux-en-Y gastric bypass (RYGB) for Biliary Reflux. METHODS: Data of OAGB patients converted to RYGB between May 2010 and December 2017 were prospectively collected and retrospectively analyzed. The afferent limb was sectioned proximally to the gastrojejunal anastomosis. A jejuno-jejunal latero-lateral anastomosis was performed between the Biliary and alimentary limb. The final RYGB had an alimentary limb of 100 cm and a Biliary limb of 150 cm. RESULTS: During the study period, 2780 patients underwent OAGB. A total of 32 patients (1.2%) underwent conversion from OAGB to RYGB for Biliary Reflux, at a mean of 30.3 months from OAGB. Mean weight before RYGB was 70.6 kg, and mean body mass index BMI was 26 kg/m(2). Four patients experienced postoperative complications (12.5%). Patients’ mean weight was 74.3 kg at 24 months follow-up, with BMI of 27.2 kg/m(2). Conversion to RYGB relieved symptoms of Biliary Reflux in all patients but 2 (93.8%). CONCLUSIONS: Biliary Reflux although rare can complicate OAGB. RYGB is a safe and feasible technique of revision in this case. A shorter length of the afferent limb during the initial operation facilitates the revision.

Jeanmarc Chevallier – 2nd expert on this subject based on the ideXlab platform

  • Long-Term Evaluation of Biliary Reflux on Esogastric Mucosae after One-Anastomosis Gastric Bypass and Esojejunostomy in Rats
    Obesity Surgery, 2020
    Co-Authors: Leïla M’harzi, Jeanmarc Chevallier, Anais Certain, Gwennhaël Autret, Guillaume Levenson, David Louis, Tigran Poghosyan, Arthur Berger, Gabriel Rahmi, Chloé Broudin

    Abstract:

    Background One-anastomosis gastric bypass/mini-gastric bypass (OAGB/MGB) remains controversial because it may cause chronic Biliary Reflux (BR). The risk of developing esogastric cancer due to BR after OAGB/MGB is based on the results of experimental rat studies using esojejunostomy (EJ). The aim of this study was to analyze the potential long-term consequences of BR on the esogastric mucosae in OAGB/MGB-operated rats and to compare these results to those from the use of EJ. Methods Wistar rats received OAGB/MGB ( n  = 16), EJ ( n  = 16), and sham ( n  = 8) operations. Mortality and weight changes were evaluated throughout the experiment. BR was measured using magnetic resonance imaging (MRI). Rats received follow-ups for 30 weeks. A double-blinded histological analysis was performed in the esogastric segments. Results BR was diagnosed in OAGB/MGB and EJ rats using the MRI technique; no BR occurred in the sham group. After a 30-week follow-up, no incidences of dysplasia or cancer were observed in the three groups. Additionally, esophageal intestinal metaplasia and mucosal ulcerations were observed in 41.7% and 50% of EJ rats, respectively, and no incidences of these conditions were observed in OAGB/MGB and sham rats. The incidence of esophagitis was significantly higher and more severe in the EJ group compared to those in the OAGB/MGB and sham groups (EJ = 100%, OAGB/MGB = 16.7%, sham = 8.3%; p  

  • long term evaluation of Biliary Reflux on esogastric mucosae after one anastomosis gastric bypass and esojejunostomy in rats
    Obesity Surgery, 2020
    Co-Authors: Leila Mharzi, Jeanmarc Chevallier, Anais Certain, Gwennhaël Autret, Guillaume Levenson, David Louis, Tigran Poghosyan, Arthur Berger, Gabriel Rahmi, Chloé Broudin

    Abstract:

    BACKGROUND: One-anastomosis gastric bypass/mini-gastric bypass (OAGB/MGB) remains controversial because it may cause chronic Biliary Reflux (BR). The risk of developing esogastric cancer due to BR after OAGB/MGB is based on the results of experimental rat studies using esojejunostomy (EJ). The aim of this study was to analyze the potential long-term consequences of BR on the esogastric mucosae in OAGB/MGB-operated rats and to compare these results to those from the use of EJ. METHODS: Wistar rats received OAGB/MGB (n = 16), EJ (n = 16), and sham (n = 8) operations. Mortality and weight changes were evaluated throughout the experiment. BR was measured using magnetic resonance imaging (MRI). Rats received follow-ups for 30 weeks. A double-blinded histological analysis was performed in the esogastric segments. RESULTS: BR was diagnosed in OAGB/MGB and EJ rats using the MRI technique; no BR occurred in the sham group. After a 30-week follow-up, no incidences of dysplasia or cancer were observed in the three groups. Additionally, esophageal intestinal metaplasia and mucosal ulcerations were observed in 41.7% and 50% of EJ rats, respectively, and no incidences of these conditions were observed in OAGB/MGB and sham rats. The incidence of esophagitis was significantly higher and more severe in the EJ group compared to those in the OAGB/MGB and sham groups (EJ = 100%, OAGB/MGB = 16.7%, sham = 8.3%; p < 0.001). CONCLUSIONS: After a 30-week follow-up period, OAGB/MGB rats did not develop any precancerous or cancerous lesions when more than 40% of EJ rats had intestinal metaplasia.

  • long term evaluation of Biliary Reflux after experimental one anastomosis gastric bypass in rats
    Obesity Surgery, 2017
    Co-Authors: Matthieu Bruzzi, Henri Duboc, Caroline Gronnier, Dominique Rainteau, Anne Couvelard, Maude Le Gall, Andre Bado, Jeanmarc Chevallier

    Abstract:

    Background
    Controversy remains regarding Biliary Reflux after one-anastomosis gastric bypass (OAGB). The aim of this “pilot” study was to analyze Biliary Reflux and its potential long-term consequences on esogastric mucosae in OAGB-operated rats.

Matthieu Bruzzi – 3rd expert on this subject based on the ideXlab platform

  • long term evaluation of Biliary Reflux after experimental one anastomosis gastric bypass in rats
    Obesity Surgery, 2017
    Co-Authors: Matthieu Bruzzi, Henri Duboc, Caroline Gronnier, Dominique Rainteau, Anne Couvelard, Maude Le Gall, Andre Bado, Jeanmarc Chevallier

    Abstract:

    Background
    Controversy remains regarding Biliary Reflux after one-anastomosis gastric bypass (OAGB). The aim of this “pilot” study was to analyze Biliary Reflux and its potential long-term consequences on esogastric mucosae in OAGB-operated rats.

  • one anastomosis gastric bypass why Biliary Reflux remains controversial
    Obesity Surgery, 2017
    Co-Authors: Matthieu Bruzzi, Jeanmarc Chevallier, Sebastien Czernichow

    Abstract:

    One-anastomosis gastric bypass is an alternative to the “gold-standard” Roux-en-Y gastric bypass. This technique appears to be safe and efficient, but controversy remains regarding the long-term theoretical risk of subsequent Biliary Reflux and its possible complications, such as cancer. The aim of the present narrative review was to summarize some of the current thoughts on Biliary Reflux. Research has established that exposure to chronic bile Reflux in humans and rats (outside the “bariatric surgery” box) induce esophageal intestinal metaplasia and esophageal adenocarcinoma. Although one-anastomosis gastric bypass can theoretically induce chronic Biliary Reflux, the incidence of Biliary Reflux and risk of cancer have not been prospectively evaluated. Clarification of this controversial issue is urgently needed.