Abstract
Background
Gastric banding (GB) is one of the most popular bariatric procedures for morbid obesity. Apart from causing weight loss by alimentary restriction, it can interfere with functions of the esophagus and upper stomach. The aim of this study was to evaluate if the results of extensive preoperative upper GI testing were correlated with long-term outcome and complications after GB.
Methods
Using a prospectively maintained computerized database including all the patients undergoing bariatric operations in both our hospitals, we performed a retrospective analysis of the patients who underwent complete upper gastrointestinal (GI) testing (endoscopy, pH monitoring, and manomatry) before GB.
Results
One hundred thirty-four patients underwent complete testing before GB. Abnormal pH monitoring (increased total reflux time, increased diurnal reflux time, increased number of reflux episodes) predicted the development of complications and especially pouch dilatation and food intolerance. The mean De Meester score was higher among patients who developed complications than in the remaining ones (25.4 vs 17.7, P = 0.03). High lower esophageal sphincter pressure also predicted progressive long-term food intolerance. Endoscopic findings were not predictive of the long-term outcome.
Conclusions
There is some association between the function of the upper digestive tract and long-term complications after gastric banding. Abnormal pH monitoring predicts overall long-term complications, especially food intolerance with or without reflux, and pouch dilatation, and a high lower esophageal sphincter pressure predicts long-term food intolerance. Extended upper gastrointestinal testing with endoscopy, 24-h pH monitoring, and esophageal manometry is probably worthwhile in selecting patients for gastric banding.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery. A systematic review and meta-analysis. JAMA 2004;292:1724–37.
Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity and health care use in morbidly obese patients. Ann Surg 2004;240:416–24.
Flum DR, Dellinger EP. Impact of gastric bypass operation on survival. A population-based analysis. J Am Coll Surg 2004;199:543–55.
Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007;357:753–61.
Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007;357:741–52.
Suter M, Calmes JM, Paroz A, Giusti V. A ten-year experience with laparoscopic gastric banding: high long-term complication and failure rates. Obes Surg 2006;16:829–35.
Suter M, Dorta G, Giusti V, Calmes JM. Gastroesophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg 2004;14:959–66.
Weiss HG, Nehoda H, Labeck B, Peer-Kühberger R, Klingler P, Gadenstätter M, et al. Treatment of morbid obesity with laparoscopic adjustable gastric banding affects esophageal motility. Am J Surg 2000;180:479–82.
Iovino P, Angrisani L, Tremolaterra F, Nirchio E, Ciannella M, Borrelli V, et al. Abnormal esophageal acid exposure is common in morbidly obese patients, and improves after successful Lap-Band system implantation. Surg Endsoc 2002;16:1631–5.
Øvrebø KK, Hatlebakk JG, Viste A, Bassøe HH, Svanes K. Gastroesophageal reflux in morbidly obese patients treated with gastric banding or vertical banded gastroplasty. Ann Surg 1998;228:51–8.
Peternac D, Hauser R, Weber M, Schöb O. The effects of laparoscopic adjustable gastric banding on the proximal pouch and the esophagus. Obes Surg 2001;11:76–86.
De Jong JR, van Ramshorst B, Timmer R, Gooszen HG, Smout AJPM. The influence of laparoscopic adjustable gastric banding on gastroesophageal reflux. Obes Surg 2004;14:399–406.
Suter M, Dorta G, Giusti V, Calmes JM. Gastric banding interferes with esophageal motility and gastroesophageal reflux. Arch Surg 2005;140:639–43.
Lew JI, Daud A, DiGorgi MF, et al. Preoperative esophageal manometry and outcome of laparoscopic adjustable gastric banding. Surg Endosc 2006;20:2142–7.
Consensus Development Conference Panel. Gastrointestinal surgery for severe obesity: consensus development conference statement. Ann Intern Med 1991;115:956–61.
Consensus sur le traitement de l’obésité en Suisse. Schweiz Med Wochenschr 1999;129 Suppl 114:4S–20S.
Ollyo JB, Lang F, Fontoillet C, Monnier P. Savary–Miller’s new classification of reflux esophagitis: a simple, reproducible, logical, complete and useful classification. Gastroenterology 1990;98:A100.
Suter M, Bettschart V, Giusti V, et al. A 3-year experience with laparoscopic gastric banding for obesity. Surg Endosc 2000;14:532–6.
Suter M, Giusti V, Worreth M, et al. Laparoscopic gastric banding. A prospective study comparing the Lapband and the SAGB: early results. Ann Surg 2005;241:55–62.
Suter M, Giusti V, Héraief E, et al. Laparoscopic gastric banding. Beyond the learning curve. Surg Endosc 2003;17:1418–25.
O’Brien PE, Dixon JB, Laurie C, Anderson M. A prospective randomized trial of placement of the laparoscopic adjustable gastric band: comparison of the perigastric and pars flaccida pathways. Obes Surg 2005;15:820–6.
Dent J, Holloway RH, Toouli J, Dodds WJ. Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastroesophageal reflux. Gut 1998;29:1020–8.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Suter, M., Giusti, V., Calmes, JM. et al. Preoperative Upper Gastrointestinal Testing Can Help Predicting Long-term Outcome After Gastric Banding for Morbid Obesity. OBES SURG 18, 578–582 (2008). https://doi.org/10.1007/s11695-007-9341-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-007-9341-6