The Eternal Dilemma of the Bile into the Gastric Pouch After OAGB: Do We Need to Worry?

Excerpt

We have read with great interest the letter entitled “Bile Reflux After One Anastomosis Gastric Bypass” [1]. Although we appreciate the eminent opinion of the author, his speculations arise from an old misunderstanding regarding the one anastomosis gastric bypass (OAGB). Despite great efforts to clarify what an OAGB is [2], this operation is still mistaken for an old Billroth II (BII) procedure. The author starts expressing his concerns on OAGB reporting long-term (17 years) results of a prospective randomized study comparing Billroth II and Roux-en-Y anastomosis for duodenal ulcer [3]. In this study, there was a significant difference in reflux symptoms, chronic atrophic gastritis, and Barrett’s esophagus in favor of the Roux-en-Y reconstruction. First, the mechanism of carcinogenesis after gastric resection for benign diseases is still controversial, even after BII, and it may be related to other factors than the simple alkaline reflux, such as the Helicobacter pylori infection [4]. Second, as said before, OAGB may resemble BII but it is a completely different procedure and no assumption on OAGB can be based on outcomes of BII. …