AJYR+GV vs RYGB for GERD

Summary

This study focuses on gastroesophageal reflux disease (GERD), a condition in which stomach acid flows back into the esophagus (the tube that carries food from the mouth to the stomach), causing heartburn and other symptoms. GERD is common among people with obesity.The standard surgical treatment for these patients is Roux-en-Y gastric bypass, a surgery that makes the stomach smaller and reroutes part of the digestive tract. This procedure promotes weight loss and usually improves reflux. However, recent studies show that up to 20% of patients continue to have, or develop, reflux after this surgery. Untreated reflux can seriously impair quality of life and may lead to complications such as esophageal ulcers and esophageal cancer. In addition, the bypass leaves parts of the digestive tract that cannot be examined with routine endoscopy, which may make it harder to detect cancers in those areas in the future.This study will compare the standard gastric bypass with a newer procedure that combines sleeve gastrectomy (removal of most of the stomach, leaving a narrow tube) with a Roux-en-Y antrum-jejunal anastomosis (a connection between the lower part of the stomach and the small intestine). This new technique may control reflux as effectively as the bypass while keeping the whole digestive tract accessible to endoscopic examination.Adults with obesity and GERD who are candidates for bariatric surgery may participate. Participants will be randomly assigned (by chance, like a coin flip) to receive one of the two procedures. The main goals of the study are to evaluate whether the new technique treats or controls reflux as well as, or better than, the standard bypass; to compare weight loss between the two procedures; to compare changes in metabolism (how the body processes sugar and fats); to check whether the duodenum (the first part of the small intestine) can be easily examined by endoscopy after the new procedure; and to understand how food moves through the digestive tract after the new procedure.

Conditions

• Obesity, Morbid
• Gastroesophageal Reflux (GERD)

Interventions

PROCEDURE

sleeve gastrectomy with Roux-en-Y antrojejunal anastomosis, AJYR+SG

Sleeve gastrectomy with Roux-en-Y antrojejunal anastomosis (AJYR+SG). The greater curvature of the stomach is released from 1 cm proximal to the pylorus to the angle of His, sealing the vessels of the right and left gastroepiploic arcades and the short gastric vessels. A sleeve gastrectomy is performed with an ascending, proximal gastric partition calibrated by a 32-Fr Fouchet bougie positioned along the lesser curvature, resulting in a gastric tube of approximately 150 mL. A Roux-en-Y reconstruction is then created: the jejunum is transected 150 cm distal to the ligament of Treitz with a 45-mm white cartridge, and an 80-cm Roux (alimentary) limb is constructed, preserving at least 3 meters of common intestinal channel. The distal jejunal limb is brought to the gastric antrum in an antecolic fashion. An antrojejunal anastomosis is created between the anterior antral wall of the gastric tube and the antimesenteric border of the jejunal limb, using a continuous, single full-thickness lay

PROCEDURE

Roux-en-Y gastric bypass, RYGB

The angle of His is dissected, and the lesser curvature of the stomach is dissected close to the gastric wall, 5 cm distal to the cardia, entering the lesser sac. A horizontal gastric stapling is performed at this level with a 45-mm blue cartridge. A 32-Fr Fouchet bougie is introduced orally and advanced to the level of the horizontal gastric partition. Two sequential vertical staple firings are then performed with two 45-mm blue cartridges, immediately adjacent to the bougie, completing the gastric partition at the angle of His, 1 cm lateral to the cardia, creating a small gastric pouch. The jejunum is transected 150 cm distal to the ligament of Treitz with a 45-mm white cartridge, preserving at least 3 meters of common intestinal channel. The distal jejunal segment (Roux alimentary limb) is brought to the small gastric pouch in an antecolic, antegastric fashion. A hand-sewn end-to-side gastrojejunal anastomosis is created with a 3-cm diameter, in a single extramucosal layer, with 3-0

Sponsors & Collaborators

• Victor Dib Institute

  lead OTHER

Principal Investigators

• Victor RM Dib, PhD · Victor Dib Institute

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

65 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-11-28

Primary Completion

2026-08-31

Completion

2030-01-31

Countries

• Brazil

Study Locations