Wireless pH-metry at the gastrojejunostomy after Roux-en-Y gastric bypass: A novel use of the BRAVO??? system

  • Hedberg J
  • Hedenström H
  • Sundbom M
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Abstract

BACKGROUND: The number of gastric bypass operations being performed is increasing rapidly due to good weight loss and alleviation of comorbidities in combination with low mortality and morbidity. Stomal ulcers are, however, a clinical problem after gastric bypass, giving patients discomfort, risk of bleeding, or even perforation. To measure the acidity in the proximal jejunum, we adopted the wireless pH-metry (BRAVO™ system) developed for evaluating reflux esophagitis.

METHODS: Twenty-five patients (4 men; median age, 44 years; body mass index, 29.3) who had undergone Roux-en-Y gastric bypass (RYGBP) 4 years earlier were recruited. Twenty-one asymptomatic, non-proton pump inhibitor (PPI) users, and in addition, four symptomatic patients (ongoing or stopped PPI treatment) were studied. The wireless BRAVO™ capsule was positioned at the level of the gastrojejunal anastomosis under visual control with the endoscope. pH was registered for up to 48 h. Time with pH
RESULTS: Of the 25 recruited patients, capsule placement was successful in all but two patients, and in three patients a constant neutral environment was seen before a premature loss of signal, indicating early loss of position. Thus, 20 successful measurements were made. The mean time of registration was 25.7 (range, 6.1-47.4) h (n=20). In the 16 asymptomatic patients, median percentage of time with pH
CONCLUSIONS: Wireless pH measurements in the proximal jejunum after gastric bypass are feasible and safe. The acidity was significant (10.5% of the registration time) even in asymptomatic patients with small gastric pouches. The described method could be useful in evaluation of epigastralgia after gastric bypass and in appraisal of PPI treatment of stomal ulcer.

Author-supplied keywords

  • Acid
  • Gastric bypass
  • Stomal ulcer
  • Ulcer
  • pH-metry

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