We have read the article by Ruiz-Tovar et al.1 with interest. They present an interesting case report describing a new indication for gastroesophageal reflux after a restrictive endoscopic procedure: conversion to one-anastomosis gastric bypass (OAGB). Despite the excellent results, the case also presents some points of conflict that may be interesting to discuss.
Firstly, the benefits of bariatric surgery in patients with grade I obesity are a topic of frequent discussion in bariatric surgery forums, and there is already evidence supporting the benefit of bariatric surgery2,3 below 35kg/m2. In this group of patients, conventional anti-reflux treatment can be equally effective.4–6 In the specific case of the patient presented with a history of the restrictive endoscopic technique, this would not be a contraindication since the fundus is usually unharmed or has minimal changes due to the plication.7,8
What is discussed in greater length is the choice of OAGB for a case like the one described. The authors have extensive long-term experience with this procedure, and their published results are excellent both in weight loss as well as short- and long-term complications. The arguments presented regarding the beneficial effect of this surgery and the morphological characteristics to prevent reflux are valid, but they clash with the general recommendations of a small reservoir for its prevention.9 On the other hand, it may be debatable to choose a malabsorptive procedure for a patient with class I obesity.
A priori, one of the weak points of the OAGB is bile reflux. Although in longer series the percentage does not exceed 10%, this is the worst enemy for a patient with reflux and esophagitis due to the risk of degeneration to Barrett's mediated by bile reflux.10 The authors cite several reviews and case series that significantly reduce this complication, but we cannot forget that this technique is still relatively young. We should point out that even gastric bypass, a common technique for patients with reflux, has a non-negligible risk of reflux recurrence.
Although the results presented are excellent, it is important to highlight that we still have many questions about whether the option presented is the most appropriate for the case presented. This case may serve to broaden the knowledge base, but we currently do not have enough evidence to be able to recommend the published strategy.
Please cite this article as: García Ruiz de Gordejuela A, Vilallonga Puy R, Roriz da Silva R, Fort López-Barajas JM. Acerca de la enfermedad por reflujo gastroesofágico en un paciente con un IMC 30kg/m2 y gastroplastia vertical endoscópica previa: indicación para un bypass gástrico de una anastomosis. Cir Esp. 2019;97:547–548.
