The Relationship Between Esophageal Peristalsis and In Vivo Intraband Pressure Measurements in Gastric Banding Patients

[Esophageal motility, symptoms, food intake and weight loss after Roux-en-Y gastric bypass]

BACKGROUND

Abnormal manometry findings can be found in the obese population. It is controversial if the manometry should be used to choose the adequate operation or if the motility status could predict symptomatic outcomes.

AIM

To correlate the esophageal motility with postoperative symptoms, alimentary outcome and weight loss after Roux-en-Y gastric bypass.

METHODS

One hundred and fourteen patients were submitted to the operation and were prospectively studied. They had no GERD symptoms or diseases that might interfere with esophageal motor function. One year after surgery patients were interviewed regarding current symptoms and eating habits.

RESULTS

Excess weight loss was 66.2 %. Sixty (52.6%) patients had an abnormal manometry. Hypertensive lower esophageal sphincter was found in 18 (16%) patients and hypotonic sphincter in 31 (27%). Dumping syndrome was mentioned by 27 (23.6%) patients and 21 (18.4%) complained of regurgitation. Excellent, good, moderate and poor alimentary outcome was present in 32 (28%), 31 (27.2%), 39 (34.2%), 12 (11.6%) patients, respectively. Sphincter pressure and esophageal amplitude did not correlate with excess weight loss. Its average was significantly higher for patients with hypertensive esophageal amplitude. Regurgitation was more frequent in patients with a hypotensive sphincter. There is no correlation between dumping and sphincter pressure status; between dumping or regurgitation and esophageal amplitude; between alimentary outcomes and sphincter pressure status or esophageal amplitude.

CONCLUSION

Esophageal manometry before Roux-en-Y gastric bypass is of limited clinical significance.

Esophageal motor responses to increasing adjustment of an implanted gastric band

BACKGROUND

The adjustable gastric band is an effective surgical treatment to induce weight loss in patients with morbid obesity. We aimed to assess the effects of band placement and stepwise adjustment on esophageal motility, using high-resolution manometry (HRM).

METHODS

Patients underwent esophageal HRM before and 6 weeks after gastric band placement. During postoperative assessment, HRM was combined with intraband pressure measurement at increasing filling volumes.

KEY RESULTS

In total, 15 patients were studied. Mean DCI (±SD) decreased from 1085.3 ± 1064.1 mmHg s(-1)  cm(-1) before to 507 ± 347.2 mmHg s(-1)  cm(-1) (P = 0.015) after band placement, mean IBP from 10.7 ± 1.7 mmHg to 7.7 ± 1.6 mmHg (P = 0.01). Stepwise band adjustment from 1 to 8 mL had an immediate and profound effect on swallow-induced esophageal contractions: DCI increased from 766 ± 590.4 to 7231 ± 6298.1 mmHg s(-1)  cm(-1) , IBP from 4.3 mmHg to 31.1 ± 17.3 mmHg, and intraband pressure increased from -109.1 ± 60.6 mmHg to 150.2 ± 65 mmHg. During band filling with volumes >5 mL, upward displacement of the LES was observed, indicative of shortening of the esophagus; the distance between the UES and LES decreased from 23.5 ± 1.3 cm at 0 mL to 19.9 ± 2 cm at 8 mL.

CONCLUSIONS & INFERENCES

Stepwise gastric band adjustment leads to immediate enforcement of esophageal peristalsis associated with an increase in intrabolus pressure and with pronounced esophageal shortening. Subjects who lack these responses to outflow obstruction may be more prone to dysphagia after band placement.