Obesity Surgery

, Volume 19, Issue 7, pp 905–914

The Effect of Laparoscopic Adjustable Gastric Bands on Esophageal Motility and the Gastroesophageal Junction: Analysis Using High-Resolution Video Manometry

Authors

    • Centre for Obesity Research and Education (CORE), Monash UniversityThe Alfred Hospital
  • Wendy Brown
    • Centre for Obesity Research and Education (CORE), Monash UniversityThe Alfred Hospital
  • Cheryl Laurie
    • Centre for Obesity Research and Education (CORE), Monash UniversityThe Alfred Hospital
  • Melissa Richards
    • Department of Gastroenterology, University of MelbourneThe Royal Melbourne Hospital
  • Sohail Afkari
    • Department of Gastroenterology, University of MelbourneThe Royal Melbourne Hospital
  • Kenneth Yap
    • Department of Nuclear MedicineThe Alfred Hospital
  • Anna Korin
    • Centre for Obesity Research and Education (CORE), Monash UniversityThe Alfred Hospital
  • Geoff Hebbard
    • Department of Gastroenterology, University of MelbourneThe Royal Melbourne Hospital
  • Paul E. O’Brien
    • Centre for Obesity Research and Education (CORE), Monash UniversityThe Alfred Hospital
Clinical Research

DOI: 10.1007/s11695-009-9845-3

Cite this article as:
Burton, P.R., Brown, W., Laurie, C. et al. OBES SURG (2009) 19: 905. doi:10.1007/s11695-009-9845-3

Abstract

Background

Laparoscopic adjustable gastric bands (LAGB) are a safe and effective treatment for obesity. Conflicting data exist concerning their effect on the esophagus, gastroesophageal junction, and mechanism of action. These patients will increasingly require accurate assessment of their esophageal function.

Methods

Twenty LAGB patients underwent high-resolution video manometry with the LAGB empty, 20% under, 20% over, and at their optimal volume. Twenty obese controls were also studied. Effects on esophageal motility, the lower esophageal sphincter (LES), and the gastroesophageal junction were measured. Transit during liquid and semisolid swallows was assessed.

Results

The intraluminal pressure at the level of LAGB was a mean of 26.9 (19.8) mm Hg. This pressure varied depending on the volume within the LAGB and was separate to and distal to the lower esophageal sphincter LES. The LES was attenuated compared to controls (10 vs 18 mm Hg; p < 0.01) although relaxed normally. Esophageal motility was well preserved at optimal volume compared to 20% overfilled, with 77% normal swallows vs 51%, p = 0.008. Repetitive esophageal contractions were observed in 40% of swallows at optimal volume compared to 16% in controls, p = 0.024. In comparison to controls, the transit of liquid, 21 vs 8 s (p < 0.001), and semisolids, 50 vs 16 s (p < 0.001), was delayed.

Conclusions

In LAGB patients, the LES is attenuated, although relaxes normally. Esophageal motility is preserved, although disrupted by overfilling the band. In the optimally adjusted LAGB, a delay in transit of liquids and semisolids through the esophagus and band is produced, along with an increase in repeated esophageal contractions.

Keywords

Laparoscopic adjustable gastric bandHigh-resolution manometryVideo manometryEsophageal motilityBariatric surgery

Copyright information

© Springer Science + Business Media, LLC 2009