12^th Global Gastroenterologists Meeting

Background: Bile reflux gastritis of the remnant stomach following Roux-en-Y gastric bypass (RYGB) causing chronic abdominal pain has not been reported. We report a series of symptomatic patients with remnant gastritis treated effectively with remnant gastrectomy.

 

Objective: To report our experience with bile reflux remnant gastritis after RYGB and our outcomes following remnant gastrectomy.

 

Setting: Community teaching hospital.

 

Methods: All patients undergoing remnant gastrectomy were retrospectively reviewed for presenting symptoms, diagnostic workup, pathology, complications, and symptom resolution.

 

Results: Nineteen patients underwent remnant gastrectomy for bile reflux gastritis at a mean of 4.4 years (52.3 months, range 8.5- 124 months) after RYGB. All patients were female and presented with pain, primarily epigastric 18/19 (95%), and described as burning 11/19 (58%), with 10/19 (53%) reporting nausea. Endoscopy was performed preoperatively on all patients with successful remnant inspection in 13 (68%), using push endoscopy (n=10) or operative assist (n=3) with 12/13 (92%) biopsy-positive for reactive gastropathy. Seventeen (90%) completed a HIDA scan with 100% positivity demonstrating bile reflux across the pylorus. Surgical approach was laparoscopic or robotic in 18 (95%) with hospital LOS of 2.7 days (range 0 to 12 d) with no major complications or readmissions. Pathology of the remnant confirmed reactive gastropathy in 90% (n=17). 90% (N=17) of patients reported sustained symptom resolution and 11% (n=2) of patients remained symptomatic at last follow up. We followed all patients for a mean of 6.6 years (1-194 months).

 

Conclusion: Bile reflux gastritis of the remnant stomach is a new consideration for chronic abdominal pain months to years following RYGB. HIDA imaging and endoscopic biopsy are highly suggestive. Remnant gastrectomy is safe and effective treatment.