Journal article
Gastric banding interferes with esophageal motility and gastroesophageal reflux.
- 2005-07-20
Published in:
- Archives of surgery (Chicago, Ill. : 1960). - 2005
Adult
Age Distribution
Body Mass Index
Esophageal Motility Disorders
Female
Follow-Up Studies
Gastric Acidity Determination
Gastric Balloon
Gastroesophageal Reflux
Gastroplasty
Humans
Incidence
Laparoscopy
Male
Manometry
Middle Aged
Obesity, Morbid
Postoperative Complications
Preoperative Care
Probability
Prospective Studies
Risk Assessment
Severity of Illness Index
Sex Distribution
Statistics, Nonparametric
English
BACKGROUND
Gastroesophageal reflux and progressive esophageal dilatation can develop after gastric banding (GB).
HYPOTHESIS
Gastric banding may interfere with esophageal motility, enhance reflux, or promote esophageal dilatation.
DESIGN
Before-after trial in patients undergoing GB.
SETTING
University teaching hospital.
PATIENTS AND METHODS
Between January 1999 and August 2002, 43 patients undergoing laparoscopic GB for morbid obesity underwent upper gastrointestinal endoscopy, 24-hour pH monitoring, and stationary esophageal manometry before GB and between 6 and 18 months postoperatively.
MAIN OUTCOME MEASURES
Reflux symptoms, endoscopic esophagitis, pressures measured at manometry, esophageal acid exposure.
RESULTS
There was no difference in the prevalence of reflux symptoms or esophagitis before and after GB. The lower esophageal sphincter was unaffected by surgery, but contractions in the lower esophagus weakened after GB, in correlation with preoperative values. There was a trend toward more postoperative nonspecific motility disorders. Esophageal acid exposure tended to decrease after GB, with fewer reflux episodes. A few patients developed massive postoperative reflux. There was no clear correlation between preoperative testing and postoperative esophageal acid exposure, although patients with abnormal preoperative acid exposure tended to maintain high values after GB.
CONCLUSIONS
Postoperative esophageal dysmotility and gastroesophageal reflux are not uncommon after GB. Preoperative testing should be done routinely. Low amplitude of contraction in the lower esophagus and increased esophageal acid exposure should be regarded as contraindications to GB. Patients with such findings should be offered an alternative procedure, such as Roux-en-Y gastric bypass.
Gastroesophageal reflux and progressive esophageal dilatation can develop after gastric banding (GB).
HYPOTHESIS
Gastric banding may interfere with esophageal motility, enhance reflux, or promote esophageal dilatation.
DESIGN
Before-after trial in patients undergoing GB.
SETTING
University teaching hospital.
PATIENTS AND METHODS
Between January 1999 and August 2002, 43 patients undergoing laparoscopic GB for morbid obesity underwent upper gastrointestinal endoscopy, 24-hour pH monitoring, and stationary esophageal manometry before GB and between 6 and 18 months postoperatively.
MAIN OUTCOME MEASURES
Reflux symptoms, endoscopic esophagitis, pressures measured at manometry, esophageal acid exposure.
RESULTS
There was no difference in the prevalence of reflux symptoms or esophagitis before and after GB. The lower esophageal sphincter was unaffected by surgery, but contractions in the lower esophagus weakened after GB, in correlation with preoperative values. There was a trend toward more postoperative nonspecific motility disorders. Esophageal acid exposure tended to decrease after GB, with fewer reflux episodes. A few patients developed massive postoperative reflux. There was no clear correlation between preoperative testing and postoperative esophageal acid exposure, although patients with abnormal preoperative acid exposure tended to maintain high values after GB.
CONCLUSIONS
Postoperative esophageal dysmotility and gastroesophageal reflux are not uncommon after GB. Preoperative testing should be done routinely. Low amplitude of contraction in the lower esophagus and increased esophageal acid exposure should be regarded as contraindications to GB. Patients with such findings should be offered an alternative procedure, such as Roux-en-Y gastric bypass.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1001/archsurg.140.7.639
- PMID 16027327
- Persistent URL
- https://sonar.ch/global/documents/277978
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