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-pH Monitoring.

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.