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Roux-en-Y After Gastric Bypass

Roux-en-Y After Gastric Bypass I read with great interest the article by Collins et al1 concerning the importance of using a Roux-en-Y loop after gastric bypass. I agree completely with all of the arguments presented by the authors. However, I would like to add an important point. As the authors state, bile reflux is an important pathogenic factor in the development of adenocarcinoma in rat esophagi and can be prevented by Roux-en-Y anastomosis. We have been performing a unique experimental procedure in patients with long-segment Barrett syndrome: partial gastrectomy and Roux-en-Y gastrojejunostomy.2,3 We have shown that with a follow-up of more than 10 years postoperatively, intestinal metaplasia can regress to cardiac mucosa in more than half of patients; but what is more important is that none of the patients have progressed to high-grade dysplasia or adenocarcinoma.4 Even low-grade dysplasia can regress to nondysplastic mucosa.5 This operation has proven to be a true antineoplastic procedure compared with classic antireflux surgery, after which adenocarcinoma can develop. We have also demonstrated that among patients with morbid obesity and Barrett syndrome, intestinal metaplasia can disappear after gastric bypass.6 I believe the authors should include this unique human clinical-experimental data in addition to the studies in rats. Correspondence: Dr Csendes, Department of Surgery, Clinical Hospital University of Chile, Santos Dumont 999, Santiago, Chile (acsendes@med.uchile.cl). Financial Disclosure: None reported. References 1. Collins BJMiyashita TSchweitzer MMagnuson THarmon J Gastric bypass: why Roux-en-Y? a review of experimental data. Arch Surg 2007;142 (10) 1000- 1003PubMedGoogle ScholarCrossref 2. Csendes ABraghetto IBurdiles PKorn O Roux en Y limb diversion as the first option for patients who have Barrett's esophagus. Chest Surg Clin N Am 2002;12 (1) 157- 184PubMedGoogle ScholarCrossref 3. Csendes ABurdiles PBraghetto IKorn ODiaz JCRojas J Early and late results of the acid suppression and duodenal diversion operation in patients with Barrett's esophagus: analysis of 210 Cases. World J Surg 2002;26 (5) 566- 576PubMedGoogle ScholarCrossref 4. Csendes ABraghetto IBurdiles PSmok GHenriquez AParada F Regression of intestinal metaplasia to cardiac od fundic mucosa in patients with Barrett's esophagus submitted to vagotomy, partial gastrectomy and duodenal diversion: a prospective study of 78 patients with more than 5 years follow up. Surgery 2006;139 (1) 46- 53PubMedGoogle ScholarCrossref 5. Csendes ASmok GBurdiles PBraghetto ICastro CKorn O Effect of duodenal diversion on low grade dysplasia in patients with Barrett's esophagus: analysis of 37 patients. J Gastrointest Surg 2002;6 (4) 645- 652PubMedGoogle ScholarCrossref 6. Csendes ABurgos AMSmok GBurdiles PHenriquez A Effect of gastric bypass on Barrett's esophagus and intestinal metaplasia of the cardia in patients with morbid obesity. J Gastrointest Surg 2006;10 (2) 259- 264PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Roux-en-Y After Gastric Bypass

Archives of Surgery , Volume 143 (8) – Aug 18, 2008

Roux-en-Y After Gastric Bypass

Abstract

I read with great interest the article by Collins et al1 concerning the importance of using a Roux-en-Y loop after gastric bypass. I agree completely with all of the arguments presented by the authors. However, I would like to add an important point. As the authors state, bile reflux is an important pathogenic factor in the development of adenocarcinoma in rat esophagi and can be prevented by Roux-en-Y anastomosis. We have been performing a unique experimental procedure in patients with...
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Publisher
American Medical Association
Copyright
Copyright © 2008 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.143.8.808-a
Publisher site
See Article on Publisher Site

Abstract

I read with great interest the article by Collins et al1 concerning the importance of using a Roux-en-Y loop after gastric bypass. I agree completely with all of the arguments presented by the authors. However, I would like to add an important point. As the authors state, bile reflux is an important pathogenic factor in the development of adenocarcinoma in rat esophagi and can be prevented by Roux-en-Y anastomosis. We have been performing a unique experimental procedure in patients with long-segment Barrett syndrome: partial gastrectomy and Roux-en-Y gastrojejunostomy.2,3 We have shown that with a follow-up of more than 10 years postoperatively, intestinal metaplasia can regress to cardiac mucosa in more than half of patients; but what is more important is that none of the patients have progressed to high-grade dysplasia or adenocarcinoma.4 Even low-grade dysplasia can regress to nondysplastic mucosa.5 This operation has proven to be a true antineoplastic procedure compared with classic antireflux surgery, after which adenocarcinoma can develop. We have also demonstrated that among patients with morbid obesity and Barrett syndrome, intestinal metaplasia can disappear after gastric bypass.6 I believe the authors should include this unique human clinical-experimental data in addition to the studies in rats. Correspondence: Dr Csendes, Department of Surgery, Clinical Hospital University of Chile, Santos Dumont 999, Santiago, Chile (acsendes@med.uchile.cl). Financial Disclosure: None reported. References 1. Collins BJMiyashita TSchweitzer MMagnuson THarmon J Gastric bypass: why Roux-en-Y? a review of experimental data. Arch Surg 2007;142 (10) 1000- 1003PubMedGoogle ScholarCrossref 2. Csendes ABraghetto IBurdiles PKorn O Roux en Y limb diversion as the first option for patients who have Barrett's esophagus. Chest Surg Clin N Am 2002;12 (1) 157- 184PubMedGoogle ScholarCrossref 3. Csendes ABurdiles PBraghetto IKorn ODiaz JCRojas J Early and late results of the acid suppression and duodenal diversion operation in patients with Barrett's esophagus: analysis of 210 Cases. World J Surg 2002;26 (5) 566- 576PubMedGoogle ScholarCrossref 4. Csendes ABraghetto IBurdiles PSmok GHenriquez AParada F Regression of intestinal metaplasia to cardiac od fundic mucosa in patients with Barrett's esophagus submitted to vagotomy, partial gastrectomy and duodenal diversion: a prospective study of 78 patients with more than 5 years follow up. Surgery 2006;139 (1) 46- 53PubMedGoogle ScholarCrossref 5. Csendes ASmok GBurdiles PBraghetto ICastro CKorn O Effect of duodenal diversion on low grade dysplasia in patients with Barrett's esophagus: analysis of 37 patients. J Gastrointest Surg 2002;6 (4) 645- 652PubMedGoogle ScholarCrossref 6. Csendes ABurgos AMSmok GBurdiles PHenriquez A Effect of gastric bypass on Barrett's esophagus and intestinal metaplasia of the cardia in patients with morbid obesity. J Gastrointest Surg 2006;10 (2) 259- 264PubMedGoogle ScholarCrossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Aug 18, 2008

Keywords: roux-en-y anastomosis,gastric bypass,gastric bypass, roux-en-y

References