Salvatore Tolone1, Edoardo Savarino2, Nicola de Bortoli3, Marzio Frazzoni4, Manuele Furnari5, Antonio d'Alessandro6, Roberto Ruggiero7, Giovanni Docimo8, Luigi Brusciano9, Simona Gili10, Raffaele Pirozzi11, Simona Parisi12, Carmine Colella13, Mariachiara Bondanese14, Beniamino Pascotto15, NunzioMattia Buonomo16, Vincenzo Savarino17, Ludovico Docimo18. 1. Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy; GISE, Gruppo Italiano per lo Studio dell'Esofago, Italy. Electronic address: salvatore.tolone@unina2.it. 2. Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; GISE, Gruppo Italiano per lo Studio dell'Esofago, Italy. Electronic address: edoardo.savarino@unipd.it. 3. Division of Gastroenterology, Department of Internal Medicine, University of Pisa, Pisa, Italy; GISE, Gruppo Italiano per lo Studio dell'Esofago, Italy. Electronic address: nick.debortoli@gmail.com. 4. Division of Gastroenterology, Baggiovara Hospital, Modena, Italy; GISE, Gruppo Italiano per lo Studio dell'Esofago, Italy. Electronic address: m.frazzoni@ausl.mo.it. 5. Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy; GISE, Gruppo Italiano per lo Studio dell'Esofago, Italy. Electronic address: manuelefurnari@gmail.com. 6. Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy. Electronic address: antodalex@gmail.com. 7. Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy. Electronic address: roberto.ruggiero@unina2.it. 8. Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy. Electronic address: giovanni.docimo@unina2.it. 9. Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy. Electronic address: luigibrusciano@tin.it. 10. Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy. Electronic address: simogili@yahoo.it. 11. Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy. Electronic address: raffale.pirozzi@studenti.unina2.it. 12. Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy. Electronic address: simona.parisi@studenti.unina2.it. 13. Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy. Electronic address: carmine.colella@studenti.unina2.it. 14. Division of Surgical Pathophysiology, Department of Surgery, Second University of Naples, Naples, Italy. Electronic address: mariachiara.bondanese@studenti.unina2.it. 15. Division of Surgical Pathophysiology, Department of Surgery, Second University of Naples, Naples, Italy. Electronic address: beniamino.pascotto@studenti.unina2.it. 16. Division of Surgical Pathophysiology, Department of Surgery, Second University of Naples, Naples, Italy. Electronic address: nunziomattia.buonomo@studenti.unina2.it. 17. Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy; GISE, Gruppo Italiano per lo Studio dell'Esofago, Italy. Electronic address: vsavarin@unige.it. 18. Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy. Electronic address: ludovico.docimo@unina2.it.
Abstract
INTRODUCTION: Obesity is a strong independent risk factor of gastroesophageal reflux disease (GERD) symptoms and hiatal hernia development. Pure restrictive bariatric surgery should not be indicated in case of hiatal hernia and GERD. However it is unclear what is the real incidence of disruption of esophagogastric junction (EGJ) in patients candidate to bariatric surgery. Actually, high resolution manometry (HRM) can provide accurate information about EGJ morphology. Aim of this study was to describe the EGJ morphology determined by HRM in obese patients candidate to bariatric surgery and to verify if different EGJ morphologies are associated to GERD-related symptoms presence. METHODS: All patients underwent a standardized questionnaire for symptom presence and severity, upper endoscopy, high resolution manometry (HRM). EGJ was classified as: Type I, no separation between the lower esophageal sphincter (LES) and crural diaphragm (CD); Type II, minimal separation (>1 and < 2 cm); Type III, >2 cm separation. RESULTS: One hundred thirty-eight obese (BMI>35) subjects were studied. Ninety-eight obese patients referred at least one GERD-related symptom, whereas 40 subjects were symptom-free. According to HRM features, EGJ Type I morphology was documented in 51 (36.9%) patients, Type II in 48 (34.8%) and Type III in 39 (28.3%). EGJ Type III subjects were more frequently associated to Symptoms than EGJ Type I (38/39, 97.4%, vs. 21/59, 41.1% p < 0.001). CONCLUSIONS: Obese subjects candidate to bariatric surgery have a high risk of disruption of EGJ morphology. In particular, obese patients with hiatal hernia often refer pre-operative presence of GERD symptoms. Testing obese patients with HRM before undergoing bariatric surgery, especially for restrictive procedures, can be useful for assessing presence of hiatal hernia.
INTRODUCTION: Obesity is a strong independent risk factor of gastroesophageal reflux disease (GERD) symptoms and hiatal hernia development. Pure restrictive bariatric surgery should not be indicated in case of hiatal hernia and GERD. However it is unclear what is the real incidence of disruption of esophagogastric junction (EGJ) in patients candidate to bariatric surgery. Actually, high resolution manometry (HRM) can provide accurate information about EGJ morphology. Aim of this study was to describe the EGJ morphology determined by HRM in obesepatients candidate to bariatric surgery and to verify if different EGJ morphologies are associated to GERD-related symptoms presence. METHODS: All patients underwent a standardized questionnaire for symptom presence and severity, upper endoscopy, high resolution manometry (HRM). EGJ was classified as: Type I, no separation between the lower esophageal sphincter (LES) and crural diaphragm (CD); Type II, minimal separation (>1 and < 2 cm); Type III, >2 cm separation. RESULTS: One hundred thirty-eight obese (BMI>35) subjects were studied. Ninety-eight obesepatients referred at least one GERD-related symptom, whereas 40 subjects were symptom-free. According to HRM features, EGJ Type I morphology was documented in 51 (36.9%) patients, Type II in 48 (34.8%) and Type III in 39 (28.3%). EGJ Type III subjects were more frequently associated to Symptoms than EGJ Type I (38/39, 97.4%, vs. 21/59, 41.1% p < 0.001). CONCLUSIONS:Obese subjects candidate to bariatric surgery have a high risk of disruption of EGJ morphology. In particular, obesepatients with hiatal hernia often refer pre-operative presence of GERD symptoms. Testing obesepatients with HRM before undergoing bariatric surgery, especially for restrictive procedures, can be useful for assessing presence of hiatal hernia.
Authors: Benjamin D Rogers; Amit Patel; Dan Wang; Gregory S Sayuk; C Prakash Gyawali Journal: Clin Gastroenterol Hepatol Date: 2019-08-20 Impact factor: 11.382