UPPER GASTROINTESTINAL ENDOSCOPIC AND HISTOLOGIC-FINDINGS BEFORE AND AFTER VERTICAL BANDED GASTROPLASTY

Background: A total of 30 consecutive morbidly obese patients, six mal es and 24 females, who underwent vertical banded gastroplasty (VBG) be tween January 1992 and December 1994 and were followed up by endoscopy and biopsy were included in this study with the aim to determine the short- and mid-term complications and to investigate alterations in es ophageal, gastric, and duodenal mucosa after surgery. Methods: All pat ients underwent endoscopy before operation. Postoperatively, 28 patien ts were reendoscoped at 6 months, 26 at 12 months, and 22 at 18 months . Biopsies were taken from the lower part of esophagus, just below the esophagogastric junction (vertical part of the partitioned stomach), corpus, antrum, and duodenal bulb. Results: Before operation 5 patient s (16.6%) had a hiatus hernia and four of them (13.3%) had esophagitis . Endoscopic gastritis was diagnosed in nine patients (30%) and endosc opic duodenitis in two (6.6%). Histologically, in 15 patients (50%) es ophagitis was recognized; in 24 patients (80%) corpus gastritis; in 27 patients (90%) antral gastritis; and in 23 (76.6%) duodenitis. Helico bacter pylori was found in 20 (66.6%) patients. Postoperatively, three patients developed a mild stoma stenosis and were treated only by pas sing the endoscope 6 months after operation; one patient, with a sever e stoma stenosis, was treated by Eder-Puestow dilatations and surgery. Gastric ulcer was found in two patients 6 and 12 months after surgery . One patient developed an endostomach channel because of staple line dehiscence 18 months after VBG. An increasing incidence of esophagitis and gastritis of the vertical part of the stomach was found at 6 and 12 months. Endoscopic and histologic gastritis of the corpus and antru m, as well as endoscopic and histologic duodenitis decreased gradually after surgery. Conclusions: Our findings suggest that postoperative c omplications of VBG can be diagnosed by endoscopy, and some of them ca n easily be managed, Vertical banded gastroplasty causes not only no h arm to the esophageal, gastric, and duodenal mucosa but also influence s them favorably.