title: Bile Reflux Scintigraphy After Mini-Gastric Bypass.
abstract: Significant weight-loss and diabetes remission have been reported after mini-gastric bypass (MGB). Concern has been raised regarding postoperative bile reflux (BR), but it has not been demonstrated in previous studies. We set out to find out if BR is evident in hepatobiliary scintigraphy after MGB.
  
  
  
  Nine consecutive patients, seven with type 2 diabetes, underwent MGB (15 cm gastric tube, 250-275 cm biliary limb) at our institution with a 12-month follow-up, with none lost to follow-up. Then, 10.7 months (8.6-13.0) after MGB, all patients underwent hepatobiliary scintigraphy and a reflux symptom questionnaire (GerdQ) was filled out. A gastroscopy with biopsies was done for all patients with a bile-reflux-positive scintigraphy.
  
  
  
  Mean age at operation was 56 years (41-65) and preoperative BMI 43.1 kg/m2(34.2-54.6). Mean %EWL was 83.9 (49.5-128.3) at 12 months. Four patients reached diabetes remission and two became insulin-independent. Hepatobiliary scintigraphy showed a transient BR into the gastric tube for five patients. Bile tracer was found in the gastric tube at 23-58 min after the tracer injection and highest activity was 8% (1-8%) at 58 min. Bile tracer was not found in the esophagus of any of the patients. One patient with a positive scintigraphy in the gastric tube required re-operation. Two patients with reflux symptoms had a negative scintigraphy.
  
  
  
  Our results indicate that transient bile reflux is common after MGB in the gastric tube, but not in the esophagus. The clinical relevance of bile reflux needs further studies.
authors.affiliation: Department of Abdominal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00029, Helsinki, HUS, Finland. tuure.saarinen@hus.fi.|Faculty of Medicine, University of Helsinki, Helsinki, Finland. tuure.saarinen@hus.fi.
authors.forename: Tuure
authors.identifier: 0000-0002-7508-4849
authors.initials: T
authors.lastname: Saarinen
authors.affiliation: Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Räsänen
authors.affiliation: Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Jarmo
authors.initials: J
authors.lastname: Salo
authors.affiliation: Department of Nuclear Medicine, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Loimaala
authors.affiliation: Department of Nuclear Medicine, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Miia
authors.initials: M
authors.lastname: Pitkonen
authors.affiliation: Department of Surgery, Central Hospital of Seinäjoki, Seinäjoki, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Leivonen
authors.affiliation: Department of Abdominal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00029, Helsinki, HUS, Finland.
authors.forename: Anne
authors.initials: A
authors.lastname: Juuti
mesh_terms: D000328:Adult; D000368:Aged; D001655:Bile Reflux / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D001659:Biliary Tract / Q000000981:diagnostic imaging; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011877:Radionuclide Imaging; D012086:Reoperation; D015431:Weight Loss
keywords: Bariatric surgery; Bile reflux; Mini-gastric bypass; Scintigraphy; Single-anastomosis gastric bypass