High-resolution Impedance Manometry after Sleeve Gastrectomy: Increased Intragastric Pressure and Reflux are Frequent Events
- 740 Downloads
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.
KeywordsBariatric surgery Gastroesophageal reflux Obesity Hiatal hernia
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 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.
- 2.Jammu GS, Sharma R. A 7-year clinical audit of 1107 cases comparing sleeve gastrectomy, roux-en-y gastric bypass, and mini-gastric bypass, to determine an effective and safe bariatric and metabolic procedure. Obes Surg 2015.Google Scholar
- 4.Melissas J, Braghetto I, Molina JC, et al. Gastroesophageal reflux disease and sleeve gastrectomy. Obes Surg. 2015;25(12):2430–5.Google Scholar
- 5.Burgerhart JS, van de Meeberg PC, Mauritz FA, et al. Increased belching after sleeve gastrectomy. Obes Surg. 2016;26(1):132–7.Google Scholar
- 6.Biter LU, Gadiot RP, Grotenhuis BA, et al. The sleeve bypass trial: a multicentre randomized controlled trial comparing the long term outcome of laparoscopic sleeve gastrectomy and gastric bypass for morbid obesity in terms of excess BMI loss percentage and quality of life. BMC Obes. 2015;2:30.CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Oor JE, Roks DJ, Unlu C, et al. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg. 2016;211(1):250–67.Google Scholar