Endoscopic Finding of Remnant 4, 5 and 6 Years After Roux-En-Y Gastric Bypass on Vertical Banded Gastroplasty: Preliminary Results of Prospective Study on 65 Consecutive Patients

Background The technique of Roux-en-Y Gastric Bypass on Vertical Banded Gastroplasty (RYGB-on-VBG) allows the traditional endoscopic evaluation of gastric remnant. Aim of the study was to detect any alteration of the excluded stomach in the mid-term post-operatively. Methods In this study were enrolled 65 consecutive patients, with mean BMI 61.8, underwent RYGB-on-VBG from 2002 to 2004.All patients had undergone gastroscopy before surgery, and at the time of follow-up nobody was under terapy with PPI . The trial started January 2008 and will be complete in August 2009. Upper endoscopy was performed with Olimpus Video Gastroscope GIF-Q 165 (Ø9,2 mm distal-end), using standard biopsy forceps in oral sedation. Biopsies of corpus, angulus and antrum of the functionally excluded stomach were done. Results Until March 2009 we collected datas of 25 asymptomatic patients with a mean BMI of 34 Kg/m2. At follow-up, for all the patients the gastroscopy of remnant was possible, and mild gastritis in 14 cases (56%) and severe gastritis in 8 cases (32%) were detected. Despite only one patient (4%) was HP positive, the histologic examination showed: 12 (48%) active gastritis, 10 (40%) mild cronic gastritis, 1 (4%) intestinal metaplasia, 1 (4%) acute lymphoma-like gastritis. Only 1 patient (4%) had a normal histologic pattern Conclusions Preliminary results of upper endoscopy after RYGB-on-VBG, showed a normal mucosal pattern of functional excluded stomach for only 3 of 25 patients (12%). The hight incidence of gastric mucosae alterations in the mid-term suggest the importance of a surgical technique wich allows the endoscopic study of the remnant.