Digestive Diseases and Sciences

, Volume 42, Issue 11, pp 2333–2337 | Cite as

The Place of Upper Gastrointestinal Tract Endoscopy Before and After Vertical Banded Gastroplasty for Morbid Obesity

  • D. Verset
  • J.-J. Houben
  • F. Gay
  • J. Elcheroth
  • V. Bourgeois
  • A. Van Gossum


In industrialized countries, surgicalgastroplasty is performed more and more frequently inpatients with morbid obesity. The aims of thisprospective study were to determine the incidence ofupper gastrointestinal lesions in obese patients and to assess theplace of digestive endoscopy in symptomatic patientsafter gastroplasty. A consecutive group of 159 obesepatients were studied before and after vertical banded gastroplasty. In the preoperative evaluation,reflux esophagitis and gastroduodenal lesions wereendoscopically observed in 31% and 37% of the patients,respectively. Interestingly, the majority of the obese patients with upper gastrointestinallesions were asymptomatic. In the postoperativefollow-up period, 55 of the 159 patients complained ofupper gastrointestinal symptoms such as vomiting (72%), esophageal reflux (17%), and epigastric pain(3%). Stenosis of the outlet of the gastric pouch wasdescribed in 40 of the 55 symptomatic patients.Esophagitis was observed in 60% of these patients.Endoscopic dilation using Savary bougies or TTS balloonwas successfully performed in all the patients withsymptomatic stenosis of the gastric outlet. Foodimpaction was endoscopically removed in four patients.Thus, we recommend performing an uppergastrointestinal endoscopy in obese patients who arecandidates for surgical gastroplasty because of the highincidence of upper gastrointestinal peptic lesions.Endoscopy is also helpful in patients with digestivedisorders occurring after gastroplasty in order todefine and to treat the lesions.



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  1. 1.
    Council on Scientific Affairs: Treatment of obesity in adults. JAMA 260:2547–2551, 1988Google Scholar
  2. 2.
    Drenick EJ, Gurunanjappa SB, Seltzer F, Johnson DG: Excessive mortality and causes of death in morbid obese men. JAMA 243:443–445, 1980Google Scholar
  3. 3.
    NIH Consensus Development Conference: Gastrointest Surg Severe Obes 9:1–16, 1991Google Scholar
  4. 4.
    Mason EE: Vertical banded gastroplasty for obesity. Arch Surg 117:701–706, 1982Google Scholar
  5. 5.
    Hall JC, Watts JMcK, O'Brien PE, Dunstan R, Walsh J. Slavotineka A, Elmslie R: Gastric surgery for morbid obesity: The Adelaide study. Ann Surg 211:419–427, 1990Google Scholar
  6. 6.
    Nightendale ML, Sarr MG, Kelly KA, Jensen MD, Zinsmeister AR, Palumbo PJ: Prospective evaluation of vertical banded gastroplasty as the primary operation for morbid obesity. Mayo Clin Proc 66:773–782, 1991Google Scholar
  7. 7.
    Laws H: Standardized gastroplasty orifice. Am J Surg 141:393–394, 1981Google Scholar
  8. 8.
    Willbanks OL: Silastic ring vertical gastroplasty (videotape). United States Surgical Corporation, Autosuture DivisionGoogle Scholar
  9. 9.
    Savary M, Miller G: L'oesophage. In Manuel et atlas d'endoscopie. SA Gassman (ed). Berne, Switzerland, Soleure, 1977, p 135Google Scholar
  10. 10.
    Zeitoun P: Lésions anatomiques de l'oesophagite peptique. In Troubles de la motricité de l'oesophage: Reflux gastrooesophagien. JP Galmiche, R Colin (eds). Paris, Doin, 1987, pp 103–120Google Scholar
  11. 11.
    Hagen J, Deitel M, Khanna RK, Ilves R: Gastroesophageal reflux in the massively obese. Int Surg 72:1–3, 1987Google Scholar
  12. 12.
    Stene-Larsen G, Weberg R, Froyshov Larsen I, Bjortuft O, Hoel B, Berstad A: Relationship of overweight to hiatus hernia and reflux oesophagitis. Scand J Gastroenterol 23:427–432, 1988Google Scholar
  13. 13.
    Mercer CD, Rue C, Hannelin L, Hill LD: Effect of obesity on esophageal transit. Am J Surg 149:177–180, 1985Google Scholar
  14. 14.
    Goldin E, Charusi I: More about stomal stenosis after surgery for morbid obesity: The endoscope as a dilatator. Gastrointest Endosc 32:432–443, 1986Google Scholar
  15. 15.
    Schrumpf E, Giercksky KE, Nygaard K, Fausa O: Gastrin secretion before and after gastric bypass surgery for morbid obesity. Scand J Gastroenterol 16:721–725, 1981Google Scholar
  16. 16.
    Miskowiak J, Andersen B, Stadil F, Fahrenkrug J: Meal stimulated levels of pancreatic polypeptide (PP) and vasoactive intestinal polypeptide (VIP) in gastroplasty for morbid obesity. Regul Pept 12:231–236, 1985Google Scholar
  17. 17.
    Miskowiak J, Andersen B, Stadil F, Schaffalitzky De Muckadell OB: Plasma secretion before and after gastroplasty for morbid obesity. Scand J Clin Lab Invest 44:363–365, 1984Google Scholar
  18. 18.
    Drenick EJ, Carlson HE, Robertson GL, Hershman JM: The role of vasopressin and prolactin in abnormal salt and water metabolism of obese patients before and after fasting and during refeeding. Metabolism 26:309–317, 1977Google Scholar
  19. 19.
    Genazzani AR, Facchinetti F, Petraglia F, Pintor C, Corda R: Hyperendorphinemia in obese children and adolescents. J Clin Endocrinol Metab 62:36–40, 1986Google Scholar
  20. 20.
    Givens JR, Wiedmann E, Andersen RN, Kitabchi AE: Beta endorphin and beta lipotropin plasma levels in hirsute women: correlation with body weight. J Clin Endocrinol Metab 50:975–976, 1980Google Scholar
  21. 21.
    Scapa E, Negri M, Halpern Z, Bogokowsky H, Eshchar J: Endoscopic diagnosis and management of complications after vertical banded gastroplasty. Endoscopy 20:11–12, 1988Google Scholar
  22. 22.
    Bademan L, Rosenborg M: The significance of gastric pouch size and emptying time for results of gastric surgery for massive obesity. Acta Chir Scand 150:549–555, 1984Google Scholar
  23. 23.
    Wayman CS, Nord HJ, Combs WM, Rosemurgy AS: The role of endoscopy after vertical banded gastroplasty. Gastrointest Endosc 38(1):44–46, 1992Google Scholar
  24. 24.
    Deitel M, Khanna RK, Hagen J, Ilves R: Vertical banded gastroplasty as an antireflux procedure. Am J Surg 155:512–516, 1988Google Scholar
  25. 25.
    Collis JL: Surgical control of reflux in hiatus hernia. Am J Surg 115:465–471, 1968Google Scholar
  26. 26.
    Buckwalter JA: Surgical treatment of morbid obesity with reflux oesophagitis. Am Surg 48:128–130, 1982Google Scholar
  27. 27.
    Kim CH, Sarr MG: Severe reflux oesophagitis after vertical banded gastroplasty for treatment of morbid obesity. Mayo Clin Proc 67:33–35, 1992Google Scholar

Copyright information

© Plenum Publishing Corporation 1997

Authors and Affiliations

  • D. Verset
  • J.-J. Houben
  • F. Gay
  • J. Elcheroth
  • V. Bourgeois
  • A. Van Gossum

There are no affiliations available

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