THE SLEEPING REMNANT

Introduction The endoscopic inaccessibility of the excluded stomach after Roux-en-Y gastric bypass (RYGB) still represent an unsolved issue for this kind of procedure. The aim of this study is to evaluate the morpho-functional modifications of the gastric remnant by using an immunoenzymatic test already validated for non-bariatric patients: the GastropanelTM. Methods A cohort of 20 patients submitted to RYGB has been prospectively enrolled and evaluated preoperatively, at 3 months and 3 years postoperatively. In addition to Gastropanel data (Pepsinogen I - acid production marker-, Pepsinogen II-inflammation marker-, Gastrin 17-reflux marker- and anti-Hpylori antibodies), biometrical and clinical data were registered. Statistical analysis was performed utilizing a general linear model. Results We registered a significant reduction of pepsinogen I (55.78-27.75-21.87, p: 0.03) and gastrin 17 ( 10.84-1.16-0.79, p: 0.04), while pepsinogen II showed a not significant early reduction (4.58-3.06-4.05). Conclusions RYGB offers a unique way to represent a model of “sleeping remnant”, by abolishing the gastric stimula to produce both acid and pepsin as well as gastrin-17. In fact, the remnant is virtually excluded from the food passage and than the gastric phase of acid secretion –responsible for more than 50% of the total acid production- results completely cancelled. By this point of view, the fall of gastric production can hardly be considered as a precancerous condition, being the gastric mucosa unexposed to carcinogenic agents.