Gastroesophageal and bile reflux after one-anastomosis gastric bypass: long-term outcomes in a functionally evaluated cohort
In brief
OAGB causes GERD in 17% and bile reflux in 20%, all needing conversion
In a cohort of 150 patients followed up to seven years, 17% developed postoperative GERD and 20% had bile reflux, the latter unresponsive to medication and requiring conversion to Roux-en-Y gastric bypass for symptom relief. All GERD cases occurred in patients with pre-operative low LES pressure, suggesting functional testing can guide patient selection.
- Journal
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Q1)
- Published
- 30 July 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- Alessandro Delcarro, Giovanni Cesana, Francesca Ciccarese, Matteo Uccelli, Adelinda Angela Giulia Zanoni, Riccardo Giorgi, et al.
- PMID
- 42624707
- DOI
- 10.1016/j.soard.2026.07.017
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 23 August 2026): GERD and bile reflux after OAGB with revisional data
Abstract
BACKGROUND: One-anastomosis gastric bypass (OAGB) is increasingly performed worldwide, but concerns persist regarding postoperative gastroesophageal reflux disease (GERD), bile reflux, and related complications. OBJECTIVES: To evaluate the incidence and clinical relevance of GERD and bile reflux after OAGB and to investigate whether preoperative esophageal functional parameters predict postoperative reflux-related complications. SETTING: Department of General Surgery, Policlinico San Marco, Bergamo, Italy. METHODS: This retrospective cohort study included 150 consecutive patients undergoing laparoscopic OAGB between 2016 and 2023. All patients underwent preoperative esophagogastroduodenoscopy and esophageal manometry, with selective pH-impedance monitoring when indicated. Postoperative GERD, esophagitis, bile reflux, anastomotic ulcers, and revisional surgery were assessed during a follow-up of 24-84 months. At last follow-up, 142 patients were available for evaluation, while 8 patients (5.3%) were lost to follow-up. RESULTS: The mean preoperative body mass index was 48 kg/m2, decreasing to 27 kg/m2 at last follow-up. Postoperative GERD developed in 26 patients (17.3%), all of whom had a preoperative hypotensive lower esophageal sphincter (LES) (<16 mmHg). Bile reflux was diagnosed in 30 patients (20%) by pH-impedance monitoring and was refractory to medical therapy in all cases, leading to conversion to Roux-en-Y gastric bypass (RYGB) with complete symptom resolution. Anastomotic ulcers occurred in 15 patients (10%), including 3 perforations (2%). No patient with normal preoperative LES pressure developed GERD or esophagitis. CONCLUSIONS: OAGB is associated with clinically relevant and likely underestimated postoperative GERD and bile reflux. In this cohort, biliary reflux was frequent and uniformly required surgical conversion to RYGB. Preoperative LES hypotonia was associated with postoperative GERD and esophagitis, supporting the role of preoperative functional evaluation in patient selection.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.