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

Dib V.R.M.; Madalosso C.A.S.; De Melo P.R.R.E.; Ramos A.C.; D’almeida L.A.V.; Antozzi L.; Del Castillo J.M.B.; Noel P.; Neto M.P.G.; Chiappetta S.; de Barros F.; Teixeira A.; Chaim E.A.; Zorron R.; de Godoy E.P.; de Aquino C.G.G.; Baretta G.A.P.; Kfouri D.S.; Júnior H.O.; Kawahara N.T.; Tinoco A.C.A.; Kruel N.T.; Junior J.J.W.; Dillenburg C.F.; Dos Santos F.A.I.; Abaid R.A.; Da Costa C.E.A.; Scortegagna G.T.; Silva G.F.; Taskin H.E.; Nassar R.M.; Layani L.A.; Caiña D.O.; Avalos M.A.; Lópes J.B.; Sotelo J.S.V.; Puy R.V.; Stier C.K.; Domene C.E.; Volpe P.; de Gordejuela A.G.R.; Poggi L.; Torres A.; Carbajo M.Á.; Braghetto I.; Ribeiro R.; Parmar C. · American Journal of Case Reports (2025) · DOI: 10.12659/ajcr.950798

Resumen

Objective: Background: Case Reports: Conclusions: Unusual clinical course 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. 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. 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. © Am J Case Rep, 2025.