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The Physiology and Pathophysiology of Gastroesophageal Reflux in Patients with Laparoscopic Adjustable Gastric Band

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Abstract

Introduction

The effect of the laparoscopic adjustable gastric band (LAGB) on esophageal acid exposure and reflux is poorly understood. Optimal technique and normative values for acid exposure have not been established in this group.

Methods

High-resolution manometry (HRM) and 24-h ambulatory esophageal pH monitoring were performed in three groups: asymptomatic LAGB, symptomatic LAGB, and pre-operative reflux patients. This technique utilized intraluminal pressure signatures during HRM to guide accurate pH sensor placement.

Results

The LAGB groups were well matched: age 48 vs 51 years (p = 0.249), weight loss 27.3 vs 26.7 kg (p = 0.911). The symptomatic group had a larger gastric pouch (5.2 vs 3.3 cm, p = 0.012), with higher esophageal acid exposure (10.8 vs 0.9%, p < 0.001). Two acidification patterns were observed: irritant and volume acidification, associated with substantial supine acidification. Symptomatic LAGB had altered esophageal motility, with poorer lower esophageal sphincter basal tone (8.0 vs 17.7 mmHg, p = 0.022) and impaired contractility of the lower esophageal segment (90 vs 40%, p = 0.009). Compared to pre-operative reflux patients, symptomatic LAGB patients demonstrated higher total and supine esophageal acid exposure (10.8 vs 7.0%, p = 0.010; 14.9 vs 5.1%, p < 0.001), less symptoms (2 vs 6, p = 0.001) and lower symptom index (0.7 vs 0.9, p = 0.010).

Conclusions

Ambulatory pH monitoring is an effective technique if the pH sensor is positioned appropriately using HRM. The correctly positioned LAGB appears associated with low esophageal acidification. In contrast, patients with symptoms or pouch dilatation can have markedly elevated esophageal acidification, particularly when supine. This is a different pattern compared to pre-operative patients and importantly can be disproportionate to symptoms.

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References

  1. Tolonen P, Victorzon M, Niemi R, et al. Does gastric banding for morbid obesity reduce or increase gastroesophageal reflux? Obes Surg. 2006;16(11):1469–74.

    Article  PubMed  Google Scholar 

  2. Dixon JB, O’Brien PE. Gastroesophageal reflux in obesity: the effect of lap-band placement. Obes Surg. 1999;9(6):527–31.

    Article  CAS  PubMed  Google Scholar 

  3. Gutschow CA, Collet P, Prenzel K, et al. Long-term results and gastroesophageal reflux in a series of laparoscopic adjustable gastric banding. J Gastrointest Surg. 2005;9(7):941–8.

    Article  PubMed  Google Scholar 

  4. Demaria EJ, Sugerman HJ, Meador JG, et al. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg. 2001;233(6):809–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Esteban Varela J, Nguyen NT. Laparoscopic sleeve gastrectomy leads the U.S. utilization of bariatric surgery at academic medical centers. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2015;11(5):987–90.

    Article  CAS  Google Scholar 

  6. Wentworth JM, Playfair J, Laurie C, et al. Multidisciplinary diabetes care with and without bariatric surgery in overweight people: a randomised controlled trial. The Lancet Diabetes & Endocrinology. 2014;2(7):545–52.

    Article  Google Scholar 

  7. Dixon JB, Eaton LL, Vincent V, et al. LAP-BAND for BMI 30-40: 5-year health outcomes from the multicenter pivotal study. Int J Obes. 2016;40(2):291–8.

    Article  CAS  Google Scholar 

  8. Burton PR, Brown W, Chen R, et al. Outcomes of high-volume bariatric surgery in the public system. ANZ J Surg. 2015;86(7–8):572–7.

  9. Burton PR, Brown WA, 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. 2010;20(3):316–25.

    Article  PubMed  Google Scholar 

  10. 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(7):905–14.

    Article  PubMed  Google Scholar 

  11. Burton PR, Yap K, Brown WA, et al. Changes in satiety, supra- and infraband transit, and gastric emptying following laparoscopic adjustable gastric banding: a prospective follow-up study. Obes Surg. 2011;21(2):217–23.

    Article  PubMed  Google Scholar 

  12. Burton PR, Brown WA, Laurie C, et al. Predicting outcomes of intermediate term complications and revisional surgery following laparoscopic adjustable gastric banding: utility of the CORE classification and Melbourne motility criteria. Obes Surg. 2010;20(11):1516–23.

    Article  PubMed  Google Scholar 

  13. 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. 2010;20(1):19–29.

    Article  PubMed  Google Scholar 

  14. Bredenoord AJ, Fox M, Kahrilas PJ, et al. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society. 2012;24(Suppl 1):57–65.

    Article  Google Scholar 

  15. Burton PR, Brown W, Laurie C, et al. Outcomes, satiety, and adverse upper gastrointestinal symptoms following laparoscopic adjustable gastric banding. Obes Surg. 2011;21(5):574–81.

    Article  PubMed  Google Scholar 

  16. Burton PR, Ooi GJ, Laurie C, et al. Changes in outcomes, satiety and adverse upper gastrointestinal symptoms following laparoscopic adjustable gastric banding. Obes Surg. 2016. doi:10.1007/s11695-016-2434-3.

  17. Ooi G, Burton P, Laurie C, et al. Nonsurgical management of luminal dilatation after laparoscopic adjustable gastric banding. Obes Surg. 2014;24:617–24.

    Article  PubMed  Google Scholar 

  18. Burton PR, Brown W, Laurie C, et al. Predicting outcomes of intermediate term complications and revisional surgery following laparoscopic adjustable gastric banding: utility of the CORE classification and Melbourne motility criteria. Obes Surg. 2010;20(11):1516–23.

  19. Burton PR, Ooi GJ, Laurie C, et al.: Diagnosis and management of oesophageal cancer in bariatric surgical patients. J Gastrointest Surg. 2016;20(10):1683–91.

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Authors and Affiliations

  1. Centre for Obesity Research and Education, Monash University, Level 6, The Alfred Centre, 99 Commercial Rd, Melbourne, 3181, Australia

    Richard Y. Chen, Paul R. Burton, Geraldine J. Ooi, Cheryl Laurie, Paul E. O’Brien & Wendy A. Brown

  2. Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Australia

    Richard Y. Chen, Paul R. Burton, Geraldine J. Ooi, Andrew I. Smith, Peter D. Nottle & Wendy A. Brown

  3. Department of Surgery, Royal Melbourne Hospital, Parkville, Australia

    Gary Crosthwaite

  4. Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Australia

    Geoff Hebbard

  5. Department of Medicine, Melbourne University, Royal Melbourne Hospital, Parkville, Australia

    Geoff Hebbard

Authors
  1. Richard Y. Chen
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  2. Paul R. Burton
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  3. Geraldine J. Ooi
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  4. Cheryl Laurie
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  5. Andrew I. Smith
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  6. Gary Crosthwaite
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  7. Paul E. O’Brien
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  8. Geoff Hebbard
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  9. Peter D. Nottle
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  10. Wendy A. Brown
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Corresponding author

Correspondence to Paul R. Burton.

Ethics declarations

Ethics

Ethics approval was obtained for this project from the Monash University Human Research Ethics Committee (no. 2006-1115-757).

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Written informed consent was obtained from all individual participants prior to recruitment and participation in this study.

Disclosures and Conflicts of Interest

Mr. Burton, Dr. Ooi, Mr. Chen, Ms. Laurie, Prof O’Brien and Prof Brown report being affiliated with the Centre for Obesity Research and Education. The Centre has received funding for research purposes from Allergan and Apollo Endosurgery, the manufacturers of the LapBand™. The grant is not tied to any specific research project, and neither Allergan nor Apollo Endosurgery had any control of the protocol, analysis and reporting of any studies. CORE also receives a grant from Applied Medical towards educational programs.

Prof Brown reports financial support for a bariatric surgery registry from the Commonwealth of Australia, Apollo Endosurgery, Covidien, Johnson and Johnson, Gore and Applied Medical. She has also received a speaker’s honorarium from Merck Sharpe and Dohme and a speaker’s honorarium and fees from participation in a scientific advisory board from Novo Nordisk. The Bariatric Registry and the honorariums are outside of the submitted work.

Dr. Ooi reports scholarships from the National Health and Medical Research Council and the Royal Australasian College of Surgeons.

Prof O’Brien has written a patient information book entitled “The Lap-Band Solution: A partnership for weight loss” which is given to patients without charge, but some are sold to surgeons and others, for which he receives a royalty.

The remaining authors have no other relevant disclosures or conflicts of interest to report.

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Chen, R.Y., Burton, P.R., Ooi, G.J. et al. The Physiology and Pathophysiology of Gastroesophageal Reflux in Patients with Laparoscopic Adjustable Gastric Band. OBES SURG 27, 2434–2443 (2017). https://doi.org/10.1007/s11695-017-2662-1

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  • DOI: https://doi.org/10.1007/s11695-017-2662-1

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