Parietal cell distribution informs gastric bypass procedure
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Citation
Abstract
INTRODUCTION: Roux-en-Y Gastric Bypass (RYGB) is a common bariatric procedure that facilitates weight loss and reduces co-morbidities of obesity. A common complication is marginal ulceration, caused by an overproduction of hydrochloric acid from the gastric pouch, and acid insult to the unprotected jejunal mucosa. The exact distribution of parietal cells in the stomach is not agreed upon. We hypothesize that there are regions of low density of parietal cells, and that these areas can allude to the optimal dimensions of the gastric pouch to reduce acid production.
METHODS: Seventeen cadaveric subjects were used in this study. A standardized schematic based on anatomical landmarks was created to examine nine operationally defined stomach segments of the cardiac and fundic stomach. Punch biopsies from the center of each of the stomach segments were collected and subsequently analyzed using immunohistochemistry. Sections were stained with Hydrogen Potassium ATPase Beta monoclonal antibody. Computational analysis was used to calculate the number of parietal nuclei per ROI area (?m2). Chi-Square Goodness of Fit analysis was performed to determine if there is a difference in parietal cell density between segments.
RESULTS: Amongst all different stomach segments, the number of parietal nuclei per ROI area (?m2) is significantly different across all sections from the expected value of all sections being equal X2(8)=21.82, p=0.005. Trends in the data illustrated that the distal lesser curvature contains a high concentration of parietal cells.
CONCLUSION: The analysis demonstrates that there is a difference in parietal cell density between various stomach segments, with some segments illustrating lower parietal cell density. These findings inform our recommendation of a horizontal gastric pouch, to include the proximal cardia and fundus adjacent to the gastroesophageal junction, in order to minimize the density of parietal cells in the gastric pouch and reduce the incidence of marginal ulceration following RYGB.