Here's a sample on how it works for me:
1. I have referenced out a Unit 99 to reference file. At that point it had 3 Pipelines in it:
2. Someone updated the OPMS afterwards, and it now has 4 Pipelines in Unit 99, 2 added newly, one deleted:
3. Once the Refresh All is done, all changes are also synced to the Active dgn file:
