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Obesity Surgery

, Volume 19, Issue 7, pp 905–914 | Cite as

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

  • Paul R. Burton
  • Wendy Brown
  • Cheryl Laurie
  • Melissa Richards
  • Sohail Afkari
  • Kenneth Yap
  • Anna Korin
  • Geoff Hebbard
  • Paul E. O’Brien
Clinical Research

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 band High-resolution manometry Video manometry Esophageal motility Bariatric surgery 

Notes

Financial Disclosure

The Centre for Obesity Research and Education has received unrestricted research funding from Allergan, Inc., the manufacturer of the LAP-BAND. None of the authors have a conflict of interest to disclose.

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Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Paul R. Burton
    • 1
  • Wendy Brown
    • 1
  • Cheryl Laurie
    • 1
  • Melissa Richards
    • 2
  • Sohail Afkari
    • 2
  • Kenneth Yap
    • 3
  • Anna Korin
    • 1
  • Geoff Hebbard
    • 2
  • Paul E. O’Brien
    • 1
  1. 1.Centre for Obesity Research and Education (CORE), Monash UniversityThe Alfred HospitalMelbourneAustralia
  2. 2.Department of Gastroenterology, University of MelbourneThe Royal Melbourne HospitalParkvilleAustralia
  3. 3.Department of Nuclear MedicineThe Alfred HospitalMelbourneAustralia

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