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April 16, 1982

Intestinal Bypass for Obesity

JAMA. 1982;247(15):2098. doi:10.1001/jama.1982.03320400018016

To the Editor.—  The article by Edward D. Kalat, MD, and David B. Martin, MD (1981;246:982), suggested that a granulomatous reaction in the liver after jejunoileal bypass was favorably influenced by reanastomosis. The accompanying editorial supported this interpretation by stating that "the granulomatous nontuberculous disorder of the liver after J-I [jejunoileal] bypass presumably resolves with restoration of bowel continuity and weight gain."Our recently published article1 consisting of an evaluation of 30 persons (from a group totaling 84 patients) on whom 101 liver biopsies were obtained at surgery and from three to nine years after jejunoileal bypass would not support the need for reanastomosis. In this study granulomas identical to those found by Drs Kalat and Martin were found initially on four biopsy samples and were not found in the later biopsy specimens, while two patients had granulomas on follow-up biopsies alone, with mild inflammation observed in all cases. Thus,