Francesco Pizza, Antonio Braun, Francesco Saverio Lucido, Stefano Cristiano, Dario D'Antonio, Libero Luca Giambavicchio, Santina Precisano, Luigi Brusciano, Salvatore Tolone, Camilla Massa, Hong Tham Santi, Maddalena Paolicelli, Chiara Dell'isola, Ludovico Docimo, Claudio Gambardella
At 5 years, OAGB provides durable weight loss with low rates of erosive esophagitis. However, gastric pouch gastritis and anastomotic ulcers remain clinically relevant, particularly in patients with modifiable risk factors; targeted endoscopic surveillance and risk-factor management may reduce long-term mucosal injury.
BACKGROUND: One-anastomosis gastric bypass (OAGB) is increasingly adopted worldwide as a primary bariatric procedure. Concerns persist regarding long-term gastroesophageal reflux disease (GERD), bile reflux, and postoperative mucosal injury. We evaluated 5-year endoscopic and histological outcomes after OAGB and their correlation with symptoms and preoperative risk factors.
METHODS: We analyzed 1,172 patients undergoing OAGB at four high-volume bariatric centers between July 2015 and February 2020. Patients with major perioperative complications, reoperations, or incomplete follow-up were excluded. Clinical assessment included the GERD-Health-Related Quality-of-Life (GERD-HRQL) questionnaire and a modified Gastrointestinal Symptom Rating Scale (GSRS) focusing on abdominal pain. Upper endoscopy (UE) with systematic biopsy of the gastric pouch was performed according to a standardized protocol.
RESULTS: Mean follow-up was 62 ± 26 months (range 60-84). Mean BMI decreased from 44.31 ± 6.28 kg/m2 to 25.1 ± 11.4 kg/m2, with %EWL 73.2 ± 22.9% and %TWL 42.6 ± 8.5%. GERD-HRQL scores were 25-29 in 26.4% and > 30 in 17.6%; among patients with scores > 30, only 35.1% had endoscopic esophagitis. Los Angeles grade A-B esophagitis was observed in 7.7%, with no cases of Barrett's esophagus. Endoscopic gastric pouch gastritis (≥ grade 1) was detected in 27.7%, whereas histology showed at least mild inflammation in 38.8% (p < 0.001). Postoperative Helicobacter pylori infection occurred in 5.4% and was associated with histological gastritis, together with smoking and alcohol consumption ≥ 3 times/week. Anastomotic ulceration occurred in 2.6%, predominantly in heavy smokers, and three cases required surgical revision.
CONCLUSIONS: At 5 years, OAGB provides durable weight loss with low rates of erosive esophagitis. However, gastric pouch gastritis and anastomotic ulcers remain clinically relevant, particularly in patients with modifiable risk factors; targeted endoscopic surveillance and risk-factor management may reduce long-term mucosal injury.