Letter to the Editor
Gastroesophageal Reflux Disease in a Patient With a BMI of 30kg/m2 and Previous Endoscopic Sleeve Gastroplasty: Indication for a One-anastomosis Gastric Bypass
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
Amador García Ruiz de Gordejuela
, Ramón Vilallonga Puy, Renato Roriz da Silva, José Manuel Fort López-Barajas
Corresponding author
Servei de Cirurgia General, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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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.</p><p id="par0010" class="elsevierStylePara elsevierViewall">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 surgery<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> below 35<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>. In this group of patients, conventional anti-reflux treatment can be equally effective.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4–6</span></a> 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.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> On the other hand, it may be debatable to choose a malabsorptive procedure for a patient with class I obesity.</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">A priori</span>, 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.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> 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.</p><p id="par0025" class="elsevierStylePara elsevierViewall">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.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">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 30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> y gastroplastia vertical endoscópica previa: indicación para un <span class="elsevierStyleItalic">bypass</span> gástrico de una anastomosis. Cir Esp. 2019;97:547–548.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedad por reflujo gastroesofágico en un paciente con un IMC 30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> y gastroplastia vertical endoscópica previa: indicación para un <span class="elsevierStyleItalic">bypass</span> gástrico de una anastomosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Ruiz-Tovar" 1 => "M.A. Carbajo" 2 => "J.M. Jimenez" 3 => "J. Ortiz-de-Solorzano" 4 => "M.J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 10 | 2 | 12 |
| 2024 September | 38 | 11 | 49 |
| 2024 August | 31 | 9 | 40 |
| 2024 July | 25 | 3 | 28 |
| 2024 June | 10 | 0 | 10 |
| 2024 May | 12 | 3 | 15 |
| 2024 April | 20 | 3 | 23 |
| 2024 March | 21 | 4 | 25 |
| 2024 February | 14 | 1 | 15 |
| 2024 January | 22 | 4 | 26 |
| 2023 December | 25 | 3 | 28 |
| 2023 November | 18 | 0 | 18 |
| 2023 October | 28 | 4 | 32 |
| 2023 September | 17 | 0 | 17 |
| 2023 August | 18 | 0 | 18 |
| 2023 July | 21 | 6 | 27 |
| 2023 June | 12 | 1 | 13 |
| 2023 May | 24 | 2 | 26 |
| 2023 April | 11 | 0 | 11 |
| 2023 March | 19 | 1 | 20 |
| 2023 February | 11 | 1 | 12 |
| 2023 January | 15 | 3 | 18 |
| 2022 December | 28 | 6 | 34 |
| 2022 November | 23 | 8 | 31 |
| 2022 October | 35 | 6 | 41 |
| 2022 September | 28 | 7 | 35 |
| 2022 August | 31 | 10 | 41 |
| 2022 July | 39 | 6 | 45 |
| 2022 June | 35 | 5 | 40 |
| 2022 May | 33 | 7 | 40 |
| 2022 April | 36 | 6 | 42 |
| 2022 March | 50 | 6 | 56 |
| 2022 February | 56 | 4 | 60 |
| 2022 January | 41 | 6 | 47 |
| 2021 December | 29 | 11 | 40 |
| 2021 November | 29 | 6 | 35 |
| 2021 October | 59 | 13 | 72 |
| 2021 September | 34 | 8 | 42 |
| 2021 August | 59 | 11 | 70 |
| 2021 July | 18 | 8 | 26 |
| 2021 June | 13 | 5 | 18 |
| 2021 May | 15 | 8 | 23 |
| 2021 April | 50 | 15 | 65 |
| 2021 March | 28 | 4 | 32 |
| 2021 February | 18 | 7 | 25 |
| 2021 January | 14 | 10 | 24 |
| 2020 December | 14 | 9 | 23 |
| 2020 November | 8 | 6 | 14 |
| 2020 October | 3 | 1 | 4 |
| 2020 September | 19 | 9 | 28 |
| 2020 August | 14 | 9 | 23 |
| 2020 July | 28 | 11 | 39 |
| 2020 June | 12 | 9 | 21 |
| 2020 May | 10 | 7 | 17 |
| 2020 April | 12 | 3 | 15 |
| 2020 March | 17 | 7 | 24 |
| 2020 February | 5 | 4 | 9 |
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