Conversion to Resectional Roux‐en‐Y Gastric Bypass for Refractory
GERD
With Predominant Non‐Acid Reflux After Single‐Anastomosis Duodenojejunal Bypass Diagnosed by Multichannel Intraluminal Impedance
Nanami Namba, Kohei Uno, Takashi Oshiro, Mizuki Fukuda, Kazuhide Sato, Keigo Hara, Takahiro Masuda, Masami Yuda, Akira Matsumoto, Yusuke Iteya, Fumiaki Yano, Ken Eto ABSTRACT
Metabolic and bariatric surgery has become routine clinical practice for severe obesity in Japan, and sleeve gastrectomy is the most performed procedure. However, bariatric procedures, including a sleeve component, may cause post‐operative gastroesophageal reflux disease (GERD) due to disruption of the angle of His and increased intra‐gastric pressure. Sleeve‐plus procedures such as single‐anastomosis duodenojejunal bypass with sleeve gastrectomy (SADJB‐SG) can also cause non‐acid reflux related to bile and pancreatic juices. Consequently, acid‐suppressive therapy is often ineffective. We report a case of refractory GERD after SADJB‐SG, in which multichannel intra‐luminal impedance (MII)–pH monitoring revealed predominant non‐acid reflux. The patient was successfully treated with conversion to resectional Roux‐en‐Y gastric bypass, which resulted in marked resolution of symptoms. This case highlights the importance of objective functional evaluation, including high‐resolution manometry and MII‐pH monitoring, to characterize reflux patterns, and to guide appropriate conversion surgery after sleeve‐plus procedures.