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Criteria for Assessing Esophageal Motility in Laparoscopic Adjustable Gastric Band Patients: The Importance of the Lower Esophageal Contractile Segment

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Abstract

Background

Esophageal function appears critical in laparoscopic adjustable gastric band (LAGB) patients; however, conventional motility assessments have not proven to be clinically useful. Recent combined video fluoroscopic and high-resolution manometric studies have identified important components of esophageal function in LAGB patients.

Methods

Successful and symptomatic LAGB patients, with normal or mildly impaired esophageal peristalsis, underwent a standardized, water swallow, high-resolution manometry protocol designed specifically to assess the lower esophageal contractile segment (LECS), in combination with conventional measures of esophageal motility. Differences in response to changes in LAGB volume were assessed.

Results

There were 101 symptomatic and 29 successful patients. More symptomatic patients had a mild impairment in esophageal motility (39.6% vs. 3.4%, p < 0.005). Successful patients demonstrated an intact LECS during normal swallows more frequently than symptomatic patients (95% vs. 43%, p < 0.005). Absolute intraluminal pressures were not different between the groups. Removing all fluid from the LAGB revealed more hypotensive swallows in the symptomatic patients (30% vs. 17%, p = 0.002), an effect not observed when the LAGB volume was increased (8% vs. 5%, p = 0.21). Receiver operator characteristic analysis determined that an intact LECS in 70% of normal swallows defined normal motility in LAGB patients.

Conclusions

The LECS is a valuable measure of esophageal function in LAGB patients and complements conventional manometric criteria. Symptomatic patients have less normal swallows; however, these also frequently demonstrate a deficient LECS. Further information can be elucidated by performing swallows at differing LAGB volumes. High-resolution manometry, using these adapted criteria, is now a useful in the investigation in symptomatic LAGB patients.

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References

  1. O'Brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032–40.

    Article  PubMed  Google Scholar 

  2. Favretti F, Ashton D, Busetto L, et al. The gastric band: first-choice procedure for obesity surgery. World J Surg. 2009;33:2039–48.

    Article  PubMed  Google Scholar 

  3. de Jong JR, Besselink MG, van Ramshorst B, et al. Effects of adjustable gastric banding on gastroesophageal reflux and esophageal motility: a systematic review. Obes Rev 2009 (in press).

  4. Korenkov M, Kohler L, Yucel N, et al. Esophageal motility and reflux symptoms before and after bariatric surgery. Obes Surg. 2002;12:72–6.

    Article  PubMed  Google Scholar 

  5. de Jong JR, van Ramshorst B, Timmer R, et al. Effect of laparoscopic gastric banding on esophageal motility. Obes Surg. 2006;16:52–8.

    Article  PubMed  Google Scholar 

  6. Burton PR, Brown WA, Laurie C, et al. The effect of laparoscopic adjustable gastric bands on esophageal motility and the gastroesophageal junction; analysis using high resolution video manometry. Obes Surg. 2009;19:905–14.

    Article  PubMed  Google Scholar 

  7. Burton PR, Brown WA, Laurie C, et al. Mechanisms of bolus clearance in patients with laparoscopic adjustable gastric bands. Obes Surg 2009 (in press).

  8. Burton PR, Brown WA, Laurie CP, et al. Effects of gastric band adjustments on intraluminal pressure. Obes Surg 2009 (in press).

  9. Kahrilas PJ, Ghosh SK, Pandolfino JE. Esophageal motility disorders in terms of pressure topography: the Chicago Classification. J Clin Gastroenterol. 2008;42:627–35.

    Article  PubMed  Google Scholar 

  10. Burton PR, Brown WA, Laurie C, et al. Pathophysiology of laparoscopic adjustable gastric bands: analysis and classification using high-resolution video manometry and a stress barium protocol. Obes Surg 2009. doi:10.1007/s11695-009-9970-z.

  11. Kahrilas PJ, Ghosh SK, Pandolfino JE. Challenging the limits of esophageal manometry. Gastroenterology. 2008;134:16–8.

    Article  PubMed  Google Scholar 

  12. Tutuian R, Castell DO. Clarification of the esophageal function defect in patients with manometric ineffective esophageal motility: studies using combined impedance-manometry. Clin Gastroenterol Hepatol. 2004;2:230–6.

    Article  PubMed  Google Scholar 

  13. Pandolfino JE, Ghosh SK, Lodhia N, et al. Utilizing intraluminal pressure gradients to predict esophageal clearance: a validation study. Am J Gastroenterol. 2008;103:1898–905.

    Article  PubMed  Google Scholar 

  14. Ghosh SK, Kahrilas PJ, Lodhia N, et al. Utilizing intraluminal pressure differences to predict esophageal bolus flow dynamics. Am J Physiol Gastrointest Liver Physiol. 2007;293:G1023–8.

    Article  CAS  PubMed  Google Scholar 

  15. Muinuddin A, Xue S, Diamant NE. Regional differences in the response of feline esophageal smooth muscle to stretch and cholinergic stimulation. Am J Physiol Gastrointest Liver Physiol. 2001;281:G1460–7.

    CAS  PubMed  Google Scholar 

  16. Cohen S, Green F. The mechanics of esophageal muscle contraction. Evidence of an inotropic effect of gastrin. J Clin Invest. 1973;52:2029–40.

    Article  CAS  PubMed  Google Scholar 

  17. Tottrup A, Forman A, Uldbjerg N, et al. Mechanical properties of isolated human esophageal smooth muscle. Am J Physiol. 1990;258:G338–43.

    CAS  PubMed  Google Scholar 

  18. Clouse RE, Staiano A. Topography of normal and high-amplitude esophageal peristalsis. Am J Physiol. 1993;265:G1098–107.

    CAS  PubMed  Google Scholar 

  19. Kahrilas PJ, Dodds WJ, Hogan WJ. Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology. 1988;94:73–80.

    CAS  PubMed  Google Scholar 

  20. Koppman JS, Poggi L, Szomstein S, et al. Esophageal motility disorders in the morbidly obese population. Surg Endosc. 2007;21:761–4.

    Article  CAS  PubMed  Google Scholar 

  21. Jaffin BW, Knoepflmacher P, Greenstein R. High prevalence of asymptomatic esophageal motility disorders among morbidly obese patients. Obes Surg. 1999;9:390–5.

    Article  CAS  PubMed  Google Scholar 

  22. Lew JI, Daud A, DiGorgi MF, et al. Preoperative esophageal manometry and outcome of laparoscopic adjustable silicone gastric banding. Surg Endosc. 2006;20:1242–7.

    Article  CAS  PubMed  Google Scholar 

  23. Brown W, Burton P, Anderson M, et al. Symmetrical pouch dilatation after laparoscopic adjustable gastric banding: incidence and management. Obes Surg. 2008;18:1104–8.

    Article  PubMed  Google Scholar 

  24. Foletto M, Bernante P, Busetto L, et al. Laparoscopic gastric rebanding for slippage with pouch dilation: results on 29 consecutive patients. Obes Surg. 2008;18:1099–103.

    Article  PubMed  Google Scholar 

  25. Muller MK, Attigah N, Wildi S, et al. High secondary failure rate of rebanding after failed gastric banding. Surg Endosc. 2008;22:448–53.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Centre for Obesity Research and Education (CORE), Monash Medical School, The Alfred Hospital, Commercial Rd Prahran, 3181, Melbourne, Australia

    Paul Robert Burton, Wendy A. Brown, Cheryl Laurie & Paul E. O’Brien

  2. Department of Gastroenterology and University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia

    Geoff Hebbard

  3. Monash University Department of Surgery, The Alfred hospital, Melbourne, Australia

    Wendy A. Brown

Authors
  1. Paul Robert Burton
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  2. Wendy A. Brown
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  3. Cheryl Laurie
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  4. Geoff Hebbard
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  5. Paul E. O’Brien
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Correspondence to Paul Robert Burton.

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Burton, P.R., Brown, W.A., Laurie, C. et al. Criteria for Assessing Esophageal Motility in Laparoscopic Adjustable Gastric Band Patients: The Importance of the Lower Esophageal Contractile Segment. OBES SURG 20, 316–325 (2010). https://doi.org/10.1007/s11695-009-0043-0

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  • DOI: https://doi.org/10.1007/s11695-009-0043-0

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