Abstract
Background
Esophageal dilatation and dysmotility are known complications of the laparoscopic adjustable gastric band (LAGB), but their incidence varies widely in the literature. There are no formal recommendations guiding surveillance for these potentially underdiagnosed pathologies. This study demonstrates the utility and outcomes of a yearly upper gastrointestinal series screening protocol to detect and manage esophageal dysfunction after LAGB.
Methods
We reviewed charts for all patients presenting for an outpatient surgical encounter related to LAGB between January 1, 2015 and December 31, 2017. Exclusion criteria included failure to undergo UGIS 6 months or more after band placement, or having undergone band placement in combination with another bariatric procedure. Descriptive statistics were used to characterize demographics, imaging findings and surgical outcomes. All imaging classifications were based on final radiologist report. Means were compared using a Student’s t test.
Results
A total of 322 records were reviewed with 39 patients excluded; 31 without UGIS and 8 with concomitant gastric bypass. 85% were female with an average age of 50 years. 66.8% identified as white or Caucasian with 24.7% black/African-American. Greater than 75% of the cohort had at least 5-year follow-up interval. UGIS was performed for symptoms in 66.1% and for routine screening in 33.9%. Of asymptomatic patients, 47.9% demonstrated esophageal dilatation or dysmotility on UGIS, similar to 51.3% of symptomatic patients. 96.8% of all patients went on to band removal. Sixty-four patients had repeat UGIS an average of 8 months following band removal, of which 40.6% were persistently abnormal.
Conclusions
The incidence of esophageal pathology was significantly higher than most reported series, as was the number of patients with persistently abnormal UGIS despite band removal. The data supports our policy of yearly UGIS for all post-LAGB patients, with strong recommendation for band removal if esophageal dilatation or dysmotility is found.
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References
Forsell P, Hallerbäck B, Glise H, Hellers G (1999) Complications following Swedish adjustable gastric banding: a long-term follow-up. Obes Surg 9(1):11–16
Weiss HG, Nehoda H, Labeck B, Peer-Kühberger MD, Klingler P, Gadenstätter M, Aigner F, Wetscher GJ (2000) Treatment of morbid obesity with laparoscopic adjustable gastric banding affects esophageal motility. Am J Surg 180(6):479–482
Wiesner W, Hauser M, Schöb O, Weber M, Hauser RS (2001) Pseudo-achalasia following laparoscopically placed adjustable gastric banding. Obes Surg 11(4):513–518
Belachew M, Belva PH, Desaive C (2002) Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 12(4):564–568
Rubenstein RB (2002) Laparoscopic adjustable gastric banding at a U.S. center with up to 3-year follow-up. Obes Surg 12(3):380–384
Ren CJ, Horgan S, Ponce J (2002) US experience with the LAP-BAND system. Am J Surg 184(6B):46S–50S
Ceelen W, Walder J, Cardon A, Van Renterghem K, Hesse U, El Malt M, Pattyn P (2003) Surgical treatment of severe obesity with a low-pressure adjustable gastric band: experimental data and clinical results in 625 patients. Ann Surg 237(1):10–16
Weiner R, Blanco-Engert R, Weiner S, Matkowitz R, Schaefer L, Pomhoff I (2003) Outcome after laparoscopic adjustable gastric banding—8 years experience. Obes Surg 13(3):427–434
Chevallier JM, Zinzindohoué F, Douard R, Blanche JP, Berta JL, Altman JJ, Cugnenc PH (2004) Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years. Obes Surg 14(3):407–414
Ren CJ, Weiner M, Allen JW (2004) Favorable early results of gastric banding for morbid obesity: the American experience. Surg Endosc 18(3):543–546
Weiss HG, Kirchmayr W, Klaus A, Bonatti H, Mühlmann G, Nehoda H, Himpens J, Aigner F (2004) Surgical revision after failure of laparoscopic adjustable gastric banding. Br J Surg 91(2):235–241
Dargent J (2005) Esophageal dilatation after laparoscopic adjustable gastric banding: definition and strategy. Obes Surg 15(6):843–848
Fielding GA, Duncombe JE (2005) Clinical and radiological follow-up of laparoscopic adjustable gastric bands, 1998 and 2000: a comparison of two techniques. Obes Surg 15(5):634–640
Lew JI, Daud A, DiGorgi MF, Olivero-Rivera L, Davis DG, Bessler M (2006) Preoperative esophageal manometry and outcome of laparoscopic adjustable silicone gastric banding. Surg Endosc 20(8):1242–1247
Milone L, Daud A, Durak E, Olivero-Rivera L, Schrope B, Inabnet WB, Davis D, Bessler M (2008) Esophageal dilation after laparoscopic adjustable gastric banding. Surg Endosc 22(6):1482–1486
Mittermair RP, Obermüller S, Perathoner A, Sieb M, Aigner F, Margreiter R (2009) Results and complications after Swedish adjustable gastric banding-10 years experience. Obes Surg 19(12):1636–1641
Robert M, Golse N, Espalieu P, Poncet G, Mion F, Roman S, Boulez J, Gouillat C (2012) Achalasia-like disorder after laparoscopic adjustable gastric banding: a reversible side effect? Obes Surg 22(5):704–711
Peternac D, Hauser R, Weber M, Schöb O (2001) The effects of laparoscopic adjustable gastric banding on the proximal pouch and the esophagus. Obes Surg 11(1):76–86
Weiss HG, Nehoda H, Labeck B, Peer-Kuehberger R, Oberwalder M, Aigner F, Wetscher GJ (2002) Adjustable gastric and esophagogastric banding: a randomized clinical trial. Obes Surg 12(4):573–578
Gutschow CA, Collet P, Prenzel K, Hölscher AH, Schneider PM (2005) Long-term results and gastroesophageal reflux in a series of laparoscopic adjustable gastric banding. J Gastrointest Surg 9(7):941–948
Klaus A, Gruber I, Wetscher G, Nehoda H, Aigner F, Peer R, Margreiter R, Weiss H (2006) Prevalent esophageal body motility disorders underlie aggravation of GERD symptoms in morbidly obese patients following adjustable gastric banding. Arch Surg 141(3):247–251
DeMaria EJ, Sugerman HJ, Meador JG, Doty JM, Kellum JM, Wolfe L, Szucs RA, Turner MA (2001) High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg 233(6):809–818
de Jong JR, Tiethof C, van Ramshorst B, Gooszen HG, Smout AJ (2009) Esophageal dilation after laparoscopic adjustable gastric banding: a more systematic approach is needed. Surg Endosc 23(12):2802–2808
Naef M, Mouton WG, Naef U, van der Weg B, Maddern GJ, Wagner HE (2011) Esophageal dysmotility disorders after laparoscopic gastric banding–an underestimated complication. Ann Surg 253(2):285–290
Suter M, Dorta G, Giusti V, Calmes JM (2005) Gastric banding interferes with esophageal motility and gastroesophageal reflux. Arch Surg 140(7):639–643
Gamagaris Z, Patterson C, Schaye V, Francois F, Traube M, Fielding CJ, Fielding GA, Youn AH, Weinshel EH (2008) Lap-band impact on the function of the esophagus. Obes Surg 18(10):1268–1272
de Jong JR, Besselink MG, van Ramshorst B, Gooszen HG, Smout AJ (2010) Effects of adjustable gastric banding on gastroesophageal reflux and esophageal motility: a systematic review. Obes Rev 11(4):297–305
Chen RY, Burton PR, Ooi GJ, Laurie C, Smith AI, Crosthwaite G, O’Brien PE, Hebbard G, Nottle PD, Brown WA (2017) The physiology and pathophysiology of gastroesophageal reflux in patients with laparoscopic adjustable gastric band. Obes Surg 27(9):2434–2443
Klaus A, Weiss H (2008) Is preoperative manometry in restrictive bariatric procedures necessary? Obes Surg 18(8):1039–1042
Zehetner J, Holzinger F, Triaca H, Klaiber Ch (2005) A 6-year experience with the Swedish adjustable gastric band prospective long-term audit of laparoscopic gastric banding. Surg Endosc 19(1):21–28
Arias IE, Radulescu M, Stiegeler R, Singh JP, Martinez P, Ramirez A, Szomstein S, Rosenthal RJ (2009) Diagnosis and treatment of megaesophagus after adjustable gastric banding for morbid obesity. Surg Obes Relat Dis 5(2):156–159
Khan A, Ren-Fielding C, Traube M (2011) Potentially reversible pseudoachalasia after laparoscopic adjustable gastric banding. J Clin Gastroenterol 45(9):775–779
Tchokouani L, Jayaram A, Alenazi N, Ranvier GF, Sam G, Kini S (2018) The long-term effects of the adjustable gastric band on esophageal motility in patients who present for band removal. Obes Surg 28(2):333–337
Kristo I, Paireder M, Jomrich G, Felsenreich DM, Nikolic M, Langer FB, Prager G, Schoppmann SF (2019) Modern esophageal function testing and gastroesophageal reflux disease in morbidly obese patients. Obes Surg. https://doi.org/10.1007/s11695-019-04020-1(Epub ahead of print)
Côté-Daigneault J, Leclerc P, Joubert J, Bouin M (2014) High prevalence of esophageal dysmotility in asymptomatic obese patients. Can J Gastroenterol Hepatol 28(6):311–314
Koppman JS, Poggi L, Szomstein S, Ukleja A, Botoman A, Rosenthal R (2007) Esophageal motility disorders in the morbidly obese population. Surg Endosc 21(5):761–764
Hong D, Khajanchee YS, Pereira N, Lockhart B, Patterson EJ, Swanstrom LL (2004) Manometric abnormalities and gastroesophageal reflux disease in the morbidly obese. Obes Surg 14(6):744–749
Suter M, Dorta G, Giusti V, Calmes JM (2004) Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg 14(7):959–966
Blam ME, Delfyett W, Levine MS, Metz DC, Katzka DA (2002) Achalasia: a disease of varied and subtle symptoms that do not correlate with radiographic findings. Am J Gastroenterol 97(8):1916–1923
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Dr. Duffy is a consultant for Lexington Medical, Inc., Bard, Medtronic, and Intuitive Surgical.Dr. Friedman has no conflicts of interest or financial ties to disclose.
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Friedman, D.T., Duffy, A.J. Outcomes of routine upper gastrointestinal series screening and surveillance after laparoscopic adjustable gastric banding. Surg Endosc 34, 2178–2183 (2020). https://doi.org/10.1007/s00464-019-07005-4
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DOI: https://doi.org/10.1007/s00464-019-07005-4