T Greilsamer1,2, M de Montrichard3,4, S Bruley des Varannes4, D Jacobi5,6, M Guillouche5, N Regenet3,4, E Mirallié3,4, C Blanchard3,4,6. 1. Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalier Universitaire (CHU) Nantes-Hôtel Dieu, Nantes, France. tristan.greilsamer@chu-nantes.fr. 2. Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Place Alexis Ricordeau, 44093, Nantes, France. tristan.greilsamer@chu-nantes.fr. 3. Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalier Universitaire (CHU) Nantes-Hôtel Dieu, Nantes, France. 4. Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Place Alexis Ricordeau, 44093, Nantes, France. 5. Department of Endocrinology, CHU de Nantes, Nantes, France. 6. L'institut du thorax, Inserm, CNRS, Université de Nantes, Nantes, France.
Abstract
BACKGROUND: Sleeve gastrectomy is the most commonly performed bariatric surgery these days but is associated with de novo reflux. OBJECTIVE: We aimed to study the influence of hypotonic lower esophageal sphincter (LES) on postoperative gastroesophageal reflux disease (GERD). METHODS: Patients with pre- and postoperative esophageal high-resolution manometry (HRM) and 24-h pH monitoring (pHM) were included retrospectively in our study. Preoperative hypotonic LES was defined by a mean residual pressure of the lower esophageal sphincter < 4 mmHg. Postoperative GERD was defined by a DeMeester's score > 14.72. We also evaluated postoperative manometric changes at the esophageal-gastric junction. RESULTS: Sixty-nine patients (54 females and 15 males) had pre- and postoperative HRM and pHM. The mean age was 45.9 ± 9.8 years. The mean body mass index (BMI) was 47.5 ± 7.5 kg/m2. Hypotonic LES concerned 21 patients (30.4%) before sleeve gastrectomy. The mean time between the two esophageal monitorings was 32.1 ± 24.1 months. The sensitivity, specificity, positive predictive value, and negative predictive value of hypotonic LES to predict GERD were 31, 70, 52, and 48% respectively. The LES minimal residual pressure was not statistically decreased after sleeve gastrectomy (p = 0.24). Only the wave speed, esophageal length, and LES length were significantly reduced after SG (p = 0.029, 3.8 × 10-7 and 0.00032). CONCLUSION: Hypotonic LES has a poor predictive value on postoperative GERD. The LES's length is significantly reduced after SG and this could be a factor explaining de novo reflux.
BACKGROUND: Sleeve gastrectomy is the most commonly performed bariatric surgery these days but is associated with de novo reflux. OBJECTIVE: We aimed to study the influence of hypotonic lower esophageal sphincter (LES) on postoperative gastroesophageal reflux disease (GERD). METHODS:Patients with pre- and postoperative esophageal high-resolution manometry (HRM) and 24-h pH monitoring (pHM) were included retrospectively in our study. Preoperative hypotonic LES was defined by a mean residual pressure of the lower esophageal sphincter < 4 mmHg. Postoperative GERD was defined by a DeMeester's score > 14.72. We also evaluated postoperative manometric changes at the esophageal-gastric junction. RESULTS: Sixty-nine patients (54 females and 15 males) had pre- and postoperative HRM and pHM. The mean age was 45.9 ± 9.8 years. The mean body mass index (BMI) was 47.5 ± 7.5 kg/m2. Hypotonic LES concerned 21 patients (30.4%) before sleeve gastrectomy. The mean time between the two esophageal monitorings was 32.1 ± 24.1 months. The sensitivity, specificity, positive predictive value, and negative predictive value of hypotonic LES to predict GERD were 31, 70, 52, and 48% respectively. The LES minimal residual pressure was not statistically decreased after sleeve gastrectomy (p = 0.24). Only the wave speed, esophageal length, and LES length were significantly reduced after SG (p = 0.029, 3.8 × 10-7 and 0.00032). CONCLUSION:Hypotonic LES has a poor predictive value on postoperative GERD. The LES's length is significantly reduced after SG and this could be a factor explaining de novo reflux.
Authors: Lorenza Alvarez Herrero; Wouter L Curvers; Frederike G I van Vilsteren; Herbert Wolfsen; Krish Ragunath; Louis-Michel Wong Kee Song; Rosalie C Mallant-Hent; Arnoud van Oijen; Pieter Scholten; Erik J Schoon; Ed B E Schenk; Bas L A M Weusten; Jacques G H M Bergman Journal: Endoscopy Date: 2013-10-28 Impact factor: 10.093
Authors: Ralph Peterli; Bettina Karin Wölnerhanssen; Thomas Peters; Diana Vetter; Dino Kröll; Yves Borbély; Bernd Schultes; Christoph Beglinger; Jürgen Drewe; Marc Schiesser; Philipp Nett; Marco Bueter Journal: JAMA Date: 2018-01-16 Impact factor: 56.272