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Background: The aims of this study are to evaluate the macroscopic and microscopic changes in the remnant stomach at mid-term follow-up of patients who underwent a Roux-en-Y gastric bypass on vertical banded gastroplasty (RYGB-on-VBG). The stomach could be reached through a 1.1-cm gastro-gastrostomy with an endoscope of standard size. Methods: From January 2009 to July 2010, 51 asymptomatic patients at 4 and 5 years follow-up after RYGB-on-VBG submitted to upper endoscopy. All of them were examined with standard endoscopy with collection of biopsies in gastric fundus, body, and antrum. The macroscopic and microscopic findings were analyzed according to Sydney Classification. Results: The endoscopy of the remnant stomach was technically easy and already showed on macroscopic examination 90 % cases of gastritis (41.2 % mild, 49 % severe) with tendency of severity in the distal stomach part. Histological analysis detected 39.2 % of active gastritis, 50.6 % of quiescent gastritis, 7.8 % of intestinal metaplasia, and 3.9 % of lymphoma-like gastritis. Conclusions: The results surprised us. We found a very high rate of mucosa abnormalities after RYGB-on-VBG. All of the patients have to be regularly controlled in follow-up and treatment has to be introduced when needed. Again, we would like to ask the question: what is happening with the remnant stomach after standard RYGB, banded gastric bapass, or minigastric bypass? Did we reach the time to answer the question? [ABSTRACT FROM AUTHOR]