Gastric Bipartition with Functional Duodenum Exclusion (GBp-FDE) as a Possible Surgical Conversion of Sleeve Gastrectomy in Patients with De Novo GERD and Obesity Recidivism: Preliminary Results of a Case Series

BACKGROUND Sleeve gastrectomy (SG) is widely used in obesity treatment, although it is associated with new onset of gastroesophageal reflux disease (de novo GERD) and weight regain. Roux-en-Y gastric bypass (RYGB) is the standard revisional procedure for GERD, though it offers limited additional weight loss. Ileal-based procedures have demonstrated superior outcomes regarding weight loss but have uncertain results in GERD. This study presents preliminary findings on gastric bipartition with functional duodenal exclusion (GBp-FDE) as a revisional approach following SG in this scenario. CASE REPORT A retrospective data analysis was conducted on 10 patients who underwent GBp-FDE due to de novo GERD and obesity recurrence after SG (mean BMI: 37.2±3.2 kg/m²). Nine patients presented with hiatal hernia and 8 with sleeve dilation. GERD was assessed pre- and postoperatively using a validated questionnaire, endoscopy, and contrast radiology. The surgical technique involved a pre-pyloric antroileostomy in Roux-en-Y configuration using a 40% proportion biliopancreatic limb. One-year postoperative findings included pyloric spasm (endoscopy), very preferential contrast flow to the ileum (radiology), and endoscopic access preservation to the duodenum. GERD symptoms resolved in 90% (P=0.0059) and esophagitis healed in 80% (P=0.008), likely due to gastric decompression. Mean percent total weight loss and percent excess weight loss were 35.2±6.6 and 108.0±11.14, respectively. CONCLUSIONS GBp-FDE seems to be a promising surgery for managing de novo GERD and obesity recurrence after SG, through SG pouch decompression and ileal stimuli, promoted by the antroileostomy. Further controlled studies with extended follow-up are necessary to validate these findings.

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Journal
American Journal of Case Reports
Published
2025-11-27
DOI
https://doi.org/10.12659/ajcr.950798
Primary Topic
Bariatric Surgery and Outcomes
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article
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article

Gastric Bipartition with Functional Duodenum Exclusion (GBp-FDE) as a Possible Surgical Conversion of Sleeve Gastrectomy in Patients with De Novo GERD and Obesity Recidivism: Preliminary Results of a Case Series

Manuel Aceves Ávalos, Luis Poggi, Carlos Augusto Scussel Madalosso, Sonja Chiappetta et al.
American Journal of Case Reports
Bariatric Surgery and Outcomes
article

Gastric Bipartition with Functional Duodenum Exclusion (GBp-FDE) as a Possible Surgical Conversion of Sleeve Gastrectomy in Patients with De Novo GERD and Obesity Recidivism: Preliminary Results of a Case Series

Manuel Aceves Ávalos, Luis Poggi, Carlos Augusto Scussel Madalosso, Sonja Chiappetta, Luiz Alfredo Vieira d’Almeida, Augusto Tinoco, Caio Gustavo Gaspar de Aquino, André L. Teixeira, Chetan D. Parmar, José M. Balibrea, Laurent Layani, Rui Ribeiro, Daniel Oscar Caiña, Ricardo Zorrón, Guilherme Henrique de Oliveira Silva, Ricardo Nassar, Fernando de Barros, Almino Cardoso Ramos, Halit Eren Taşkın, Gabriela Trentin Scortegagna, Victor Ramos Mussa Dib, Nilton Kawahara, Manoel Galvão Neto, Carlos Frota Dillenburg, José Sergio Verboonen Sotelo, Ramón Vilallonga, Carlos Eduardo Domene, Rafael Antoniazzi Abaid, Luciano Antozzi, Paula VOLPE, Christine Stier, Amador García Ruiz de Gordejuela, Patrick Noe͏̈l, Paulo Melo, Giórgio Alfredo Pedroso Baretta, Italo Braghetto, F. Santos, Antoní Torres, Carlos da Silva Costa, Eudes Paiva de Godoy, Elinton Adami Chaim, Miguel Ángel Martín Carbajo, Jorge Lopes, Hiroji Okano Júnior, Nicholas Tavares Kruel, Diogo Swain Kfouri, Joe Joaquim Waltrick
article en

Abstract

BACKGROUND Sleeve gastrectomy (SG) is widely used in obesity treatment, although it is associated with new onset of gastroesophageal reflux disease (de novo GERD) and weight regain. Roux-en-Y gastric bypass (RYGB) is the standard revisional procedure for GERD, though it offers limited additional weight loss. Ileal-based procedures have demonstrated superior outcomes regarding weight loss but have uncertain results in GERD. This study presents preliminary findings on gastric bipartition with functional duodenal exclusion (GBp-FDE) as a revisional approach following SG in this scenario. CASE REPORT A retrospective data analysis was conducted on 10 patients who underwent GBp-FDE due to de novo GERD and obesity recurrence after SG (mean BMI: 37.2±3.2 kg/m²). Nine patients presented with hiatal hernia and 8 with sleeve dilation. GERD was assessed pre- and postoperatively using a validated questionnaire, endoscopy, and contrast radiology. The surgical technique involved a pre-pyloric antroileostomy in Roux-en-Y configuration using a 40% proportion biliopancreatic limb. One-year postoperative findings included pyloric spasm (endoscopy), very preferential contrast flow to the ileum (radiology), and endoscopic access preservation to the duodenum. GERD symptoms resolved in 90% (P=0.0059) and esophagitis healed in 80% (P=0.008), likely due to gastric decompression. Mean percent total weight loss and percent excess weight loss were 35.2±6.6 and 108.0±11.14, respectively. CONCLUSIONS GBp-FDE seems to be a promising surgery for managing de novo GERD and obesity recurrence after SG, through SG pouch decompression and ileal stimuli, promoted by the antroileostomy. Further controlled studies with extended follow-up are necessary to validate these findings.

American Journal of Case ReportsVol. 26
Universidad de Santiago de Chile (CL), Universidad de Valladolid (ES), Universidad Complutense de Madrid (ES), Orlando Health (US), Universidade Federal Fluminense (BR), Universidade Federal de Pelotas (BR), University of Mannheim (DE), Universidade Estadual de Campinas (UNICAMP) (BR), Universidade de Santa Cruz do Sul (BR), Heidelberg University (DE), Oasis Hospital (AE), Victim Support (GB), Hospital Israelita Albert Einstein (BR), Regione Campania (IT), University Hospital Heidelberg (DE), Hospital Clínico San Carlos (ES), Centro Universitário Curitiba (BR), Universidade Federal do Rio Grande do Norte (BR), Fundação de Apoio a Pesquisa do Estado de Goiás (BR), Assistance Publique Hôpitaux de Marseille (FR), Secretaría de Salud de Jalisco (MX), Centro Universitário de Jaraguá do Sul (BR), Hospital São José do Avaí (BR), Hospital Universitário Onofre Lopes (BR), Hospital Prof. Dr. Fernando Fonseca (PT), Clinica Gastrobese (BR), Centro Clinico Nemo (IT), Instituto de Diagnóstico e Investigaciones Metabólicas (AR), Anglo American (United Kingdom) (GB), Istanbul University-Cerrahpaşa (TR), Instituto de Tecnologia do Paraná (BR), Gastro Obeso Center (BR), Centro Científico Tecnológico - Bahía Blanca (AR), Vall d'Hebron Hospital Universitari (ES), Whittington Health NHS Trust (GB), Hospital Clínico de la Universidad de Chile (CL), Fundación Santa Fe de Bogotá (CO), Universidad del Desarrollo Profesional (MX), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (BR), Barber-Nichols (United States) (US), Hospital Pró-Cardíaco (BR), Hospital Universitari Germans Trias i Pujol (ES), University Medical Centre Mannheim (DE), Hospital do Desterro (PT), University of Chile (CL), Chartered Institute of Management Accountants (GB)
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Bariatric Surgery and Outcomes
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