Abstract
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Dixon JB, Chapman L, O'Brien P. Marked improvement in asthma after Lap-Band surgery for morbid obesity. Obes Surg. 1999;9:385–9.
O'Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med. 2006;144:625–33.
Chapman AE, Kiroff G, Game P, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery. 2004;135:326–51.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. Jama. 2004;292:1724–37.
Dixon JB, Bhathal PS, Hughes NR, et al. Nonalcoholic fatty liver disease: improvement in liver histological analysis with weight loss. Hepatology. 2004;39:1647–54.
Dixon JB, O'Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299:316–23.
O'Brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032–40.
O'Brien PE, Brown WA, Smith A, et al. Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity. Br J Surg. 1999;86:113–8.
Dixon AF, Dixon JB, O'Brien PE. Laparoscopic adjustable gastric banding induces prolonged satiety: a randomized blind crossover study. J Clin Endocrinol Metab. 2005;90:813–9.
Suter M, Dorta G, Giusti V, et al. Gastric banding interferes with esophageal motility and gastroesophageal reflux. Arch Surg. 2005;140:639–43.
DeMaria EJ, Sugerman HJ, Meador JG, et al. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg. 2001;233:809–18.
Korenkov M, Kohler L, Yucel N, et al. Esophageal motility and reflux symptoms before and after bariatric surgery. Obes Surg. 2002;12:72–6.
Gamagaris Z, Patterson C, Schaye V, et al. Lap-band impact on the function of the esophagus. Obes Surg. 2008;18:1268–72.
Tolonen P, Victorzon M, Niemi R, et al. Does gastric banding for morbid obesity reduce or increase gastroesophageal reflux? Obes Surg. 2006;16:1469–74.
Weiss HG, Nehoda H, Labeck B, et al. Treatment of morbid obesity with laparoscopic adjustable gastric banding affects esophageal motility. Am J Surg. 2000;180:479–82.
de Jong JR, van Ramshorst B, Timmer R, et al. Effect of laparoscopic gastric banding on esophageal motility. Obes Surg. 2006;16:52–8.
Grubel C, Hiscock R, Hebbard G. Value of spatiotemporal representation of manometric data. Clin Gastroenterol Hepatol. 2008;6:525–30.
Fox MR, Bredenoord AJ. Oesophageal high-resolution manometry: moving from research into clinical practice. Gut. 2008;57:405–23.
Kahrilas PJ, Ghosh SK, Pandolfino JE. Esophageal motility disorders in terms of pressure topography: the Chicago Classification. J Clin Gastroenterol. 2008;42:627–35.
O'Rourke RW, Seltman AK, Chang EY, et al. A model for gastric banding in the treatment of morbid obesity: the effect of chronic partial gastric outlet obstruction on esophageal physiology. Ann Surg. 2006;244:723–33.
Brown WA, Burton PR, Anderson M, et al. Symmetrical pouch dilatation after laparoscopic adjustable gastric banding: incidence and management. Obes Surg. 2008;18:1104–8.
Financial Disclosure
The Centre for Obesity Research and Education has received unrestricted research funding from Allergan, Inc., the manufacturer of the LAP-BAND. None of the authors have a conflict of interest to disclose.
Author information
Authors and Affiliations
Corresponding author
Additional information
Paul Burton has received funding from the National Health and Medical Research Council (NHMRC) and the Royal Australasian College of Surgeons.
Rights and permissions
About this article
Cite this article
Burton, P.R., Brown, W., Laurie, C. et al. The Effect of Laparoscopic Adjustable Gastric Bands on Esophageal Motility and the Gastroesophageal Junction: Analysis Using High-Resolution Video Manometry. OBES SURG 19, 905–914 (2009). https://doi.org/10.1007/s11695-009-9845-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-009-9845-3