Obesity Surgery

, Volume 26, Issue 10, pp 2449–2456 | Cite as

High-resolution Impedance Manometry after Sleeve Gastrectomy: Increased Intragastric Pressure and Reflux are Frequent Events

  • François MionEmail author
  • Salvatore Tolone
  • Aurélien Garros
  • Edoardo Savarino
  • Elise Pelascini
  • Maud Robert
  • Gilles Poncet
  • Pierre-Jean Valette
  • Sophie Marjoux
  • Ludovico Docimo
  • Sabine Roman
Original Contributions


Introduction and Purpose

Sleeve gastrectomy (SG) is gaining ground in the field of bariatric surgery. Data are scarce on its impact on esophagogastric physiology. Our aim was to evaluate the impact of SG on esophagogastric motility with high-resolution impedance manometry (HRIM) and to assess the usefulness of HRIM in patients with upper gastrointestinal (GI) symptoms after SG.


A retrospective analysis of 53 cases of HRIM performed after SG was conducted. Upper GI symptoms at the time of HRIM were scored. HRIM was analyzed according to the Chicago classification v3.0. A special attention was devoted to the occurrence of increased intragastric pressure (IIGP) after water swallows and reflux episodes as detected with impedance. A measurement of sleeve volume and diameter was performed with CT scan in a subgroup of patients.


IIGP occurred very frequently in patients after SG (77 %) and was not associated with any upper GI symptoms, specific esophageal manometric profile, or impedance reflux. Impedance reflux episodes were also frequently observed after SG (52 %): they were significantly associated with gastroesophageal reflux (GER) symptoms and ineffective esophageal motility. The sleeve volume and diameters were also significantly smaller in patients with impedance reflux episodes (p < 0.01).


SG significantly modified esophagogastric motility. IIGP is frequent, not correlated to symptoms, and should be regarded as a HRIM marker of SG. Impedance reflux episodes were also frequent, associated with GER symptoms and esophageal dysmotility. HRIM may thus have a clinical impact on the management of patients with upper GI symptoms after SG.


Bariatric surgery Gastroesophageal reflux Obesity Hiatal hernia 


Author Contributions

FM, ST, and SR were responsible for the study concept and design, acquisition of the data, analysis and interpretation of the data, drafting the manuscript, and approval of the final version of the manuscript.

SM, EP, MR, GP, PJV, and AG were responsible for the acquisition of the data, analysis and interpretation of the data, drafting the manuscript, and approval of the final version of the manuscript.

ES and LD were responsible for the analysis and interpretation of the data, drafting of the manuscript, and approval of the final version of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

FM was a consultant for Medtronic; ES and SR were consultants for Medtronic, Sandhill; and ST, LD, AG, SM, MR, GP, EP, and PJV declare no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human Rights

All procedures performed 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.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • François Mion
    • 1
    Email author
  • Salvatore Tolone
    • 2
  • Aurélien Garros
    • 3
  • Edoardo Savarino
    • 4
  • Elise Pelascini
    • 5
  • Maud Robert
    • 5
  • Gilles Poncet
    • 5
  • Pierre-Jean Valette
    • 6
  • Sophie Marjoux
    • 3
  • Ludovico Docimo
    • 2
  • Sabine Roman
    • 3
  1. 1.Pavillon L, Hospital E. HerriotLyonFrance
  2. 2.Division of General and Bariatric SurgeryUniversity of Naples S.U.NCasertaItaly
  3. 3.Hospices Civils de Lyon, Hospital E. Herriot, Digestive Physiology, Lyon, & University Lyon ILyonFrance
  4. 4.GastroenterologyUniversity of PadovaPadovaItaly
  5. 5.Hospices Civils de Lyon, Hospital E. Herriot, Digestive and Bariatric SurgeryLyonFrance
  6. 6.Hospices Civils de Lyon, Radiology Department, Lyon, & University Lyon 1LyonFrance

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