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.
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.
Authors: Andrew E Chapman; George Kiroff; Philip Game; Bruce Foster; Paul O'Brien; John Ham; Guy J Maddern Journal: Surgery Date: 2004-03 Impact factor: 3.982
Authors: Robert W O'Rourke; Ann K Seltman; Eugene Y Chang; Kevin M Reavis; Brian S Diggs; John G Hunter; Blair A Jobe Journal: Ann Surg Date: 2006-11 Impact factor: 12.969
Authors: H G Weiss; H Nehoda; B Labeck; M D Peer-Kühberger; P Klingler; M Gadenstätter; F Aigner; G J Wetscher Journal: Am J Surg Date: 2000-12 Impact factor: 2.565
Authors: Sabine Roman; John E Pandolfino; Joan Chen; Lubomyr Boris; Daniel Luger; Peter J Kahrilas Journal: Am J Gastroenterol Date: 2011-09-20 Impact factor: 10.864
Authors: Paul Robert Burton; Kenneth Yap; Wendy A Brown; Cheryl Laurie; Matthew O'Donnell; Geoff Hebbard; Victor Kalff; Paul E O'Brien Journal: Obes Surg Date: 2010-12 Impact factor: 4.129
Authors: Paul Robert Burton; Wendy A Brown; Cheryl Laurie; Melissa Richards; Geoff Hebbard; Paul E O'Brien Journal: Obes Surg Date: 2009-11 Impact factor: 4.129
Authors: Peter J Kahrilas; Albert J Bredenoord; Mark Fox; C Prakash Gyawali; Sabine Roman; André J P M Smout; John E Pandolfino Journal: Nat Rev Gastroenterol Hepatol Date: 2017-09-27 Impact factor: 46.802