Evaluation of the risk of esogastric cancer induced by biliary reflux after omega-loop gastric bypass

Introduction : Il existe une importante controverse concernant le risque de reflux biliaire après by-pass gastrique en oméga ou mini bypass gastrique (BPGO), car le montage en oméga peut entrainer le passage direct des sucs billion-pancréatiques dans le tube gastrique du bypass. Plusieurs études chez l'homme et l'animal (certes, en dehors du champ de la chirurgie bariatrique) ont démontré que l'exposition chronique de l’œsophage à un reflux biliaire pouvait entrainer une métaplasie intestinale, de la dysplasie et de l'adénocarcinome de l’œsophage. L'objectif de cette étude pilote est d'analyser le reflux biliaire et ses éventuelles conséquences à long terme sur les muqueuses peso-gastriques chez des rats opérés de BPGO. Méthode : Des rats rendus obèses ont été opérés et répartis en 2 groupes : BPGO (n=10) et SHAM (n=4). Les rats ont été suivis pendant 16 semaines, soit un équivalent chez l'homme de 10 ans. L'évolution du poids et des paramètres glycériques a été analysé. La mesure des concentration d'acides biliaires, les analyses histologiques et bio-moléculaires par qRTPCR ont été réalisées sur les segments œsogastriques. Résultats : L'évolution du poids et de la tolérance au glucose était améliorée après BPGO. La concentration moyenne en acides biliaires était 4,2 fois plus importante dans les segments œsogastriques des rats BPGO en comparaison aux rats SHAM. Une hyperplasie fovéolaire de l'anastomose gastro-jéjunale et une infiltration en polynucléaires éosinophiles étaient observées après BPGO. Une hyperpapillomatose œsophagienne était présente dans les 2 groupes (BPGO=50%, SHAM=50%). Les analyses par qRTPCR n'ont pas retrouvé dans les muqueuses œsogastriques de différence concernant les taux d'ARNm des gènes spécifiques d'œsophage de Barrett ou de cancer. À 16 semaines, nous n'avons observé ni métaplasie, ni dysplasie, ni cancer. Conclusion : Après un suivi de 16 semaines, cette étude pilote a confirmé la bonne reproductibilité du model de BPGO chez le rat. Aucune lésion pré-cancéreuse ou cancéreuse n'a été observée chez les rat BPGO.Background: Controversy remains regarding biliary reflux after one-anastomosis gastric bypass (OAGB) or mini-gastric bypass, because the omega loop montage may induce direct reflux of biliopancreatic juice within the gastric pouch. Previous research outside the "bariatric surgery" box has established that exposure to chronic bile reflux in humans and rats induces esophageal intestinal metaplasia, dysplasia, and esophageal adenocarcinoma. Objectives: The aim of this pilot study was to analyze biliary reflux and its potential long-term consequences on esogastric mucosae in OAGB operated rats. Methods: Diet-induced obese rats were subjected to OAGB (n = 10) or sham (n = 4) surgery and followed up for 16 weeks. Evolution of weight and glucose tolerance was analyzed. Bile acid concentration measurement, histological and qRT-PCR analysis were performed in the esogastric segments. Results: Weight loss and glucose tolerance were improved after OAGB. Mean bile acid concentration was 4.2 times higher in the esogastric segments of OAGB rats (compared to sham). A foveolar hyperplasia of the gastro-jejunal anastomosis and an eosinophilic polynuclear cell infiltration were observed in OAGB rats. An esophageal hyper-papillomatosis was observed in both groups (OAGB = 50%, sham = 50%). qRTPCR analysis showed no differences between OAGB and sham mRNA levels of Barrett's esophagus or esogastric carcinogenic-specific genes. No intestinal metaplasia, dysplasia, or cancer were observed after a 16-week follow-up. Conclusions: After a 16-week follow-up, this pilot study confirmed the good reproducibility of our OAGB rat model. OAGB rats had not developed any pre-cancerous or cancerous lesions

Fate of the distal aorta after surgical repair of acute DeBakey type I aortic dissection: A review

SummaryOperated acute DeBakey type I aortic dissection has to be considered as a chronic aortic disease with the potential of late distal dilatation with aneurysm formation and need for reoperation. Several intraoperative strategies have been devised to prevent late complications. However, the increased operative risk associated with a more aggressive initial approach in an emergent setting has to be balanced against the relatively low incidence of late reoperations. Further studies will have to identify preoperative risk factors for late distal aortic complications more precisely in order to select patients who might benefit the most from these newer surgical strategies

One anastomosis gastric bypass and esojejunostomy in rats: surgical techniques

One anastomosis gastric bypass (OAGB) is a popular bariatric procedure, but controversies remain regarding biliary reflux and the potential risk of cancer. Esophagojejunostomy (EJ) in rats is a validated and reproducible model for the development of metaplasia [Barett’s esophagus (BE)] and esophageal adenocarcinoma (EA) with a minimal exposure of 12 to 20 weeks. We are analyzing the risks of BE and EA in an OAGB rat model and comparing these with the EJ rat model. The purpose of this study is to describe our OAGB and EJ techniques in rats that we used to evaluate biliary reflux and share our experience with scientists and the bariatric community. These operations are short and simple procedures with acceptable morbidity

Outcomes of rescue procedures in the management of locally recurrent ampullary tumors: A Pancreas 2000/EPC study

International audienceBackground: Ampullary lesions are rare and can be locally treated either with endoscopic papillectomy or transduodenal surgical ampullectomy. Management of local recurrence after a first-line treatment has been poorly studied.Methods: Patients with a local recurrence of an ampullary lesion initially treated with endoscopic papillectomy or transduodenal surgical ampullectomy were retrospectively included from a multi-institutional database (58 centers) between 2005 and 2018.Results: A total of 103 patients were included, 21 (20.4%) treated with redo endoscopic papillectomy, 14 (13.6%) with transduodenal surgical ampullectomy, and 68 (66%) with pancreaticoduodenectomy. Redo endoscopic papillectomy had low morbidity with 4.8% (n = 1) severe to fatal complications and a R0 rate of 81% (n = 17). Transduodenal surgical ampullectomy and pancreaticoduodenectomy after a first procedure had a higher morbidity with Clavien III and more complications, respectively, 28.6% (n = 4) and 25% (n = 17); R0 resection rates were 85.7% (n = 12) and 92.6% (n = 63), both without statistically significant difference compared to endoscopic papillectomy (P = .1 and 0.2). Pancreaticoduodenectomy had 4.4% (n = 2) mortality. No deaths were registered after transduodenal surgical ampullectomy or endoscopic papillectomy. Recurrences treated with pancreaticoduodenectomy were more likely to be adenocarcinomas (79.4%, n = 54 vs 21.4%, n = 3 for transduodenal surgical ampullectomy and 4.8%, n = 1 for endoscopic papillectomy, P < .0001). Three-year overall survival and disease-free survival were comparable.Conclusion: Endoscopy is appropriate for noninvasive recurrences, with resection rate and survival outcomes comparable to surgery. Surgery applies more to invasive recurrences, with transduodenal surgical ampullectomy rather for carcinoma in situ and early cancers and pancreaticoduodenectomy for more advanced tumors