Skip to main content
SpringerLink
Log in

Effect of morbid obesity, gastric banding and gastric bypass on esophageal symptoms, mucosa and function

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Obesity and gastroesophageal reflux disease (GERD) are commonly associated diseases. Bariatric surgery has been shown to have various impacts on esophageal function and GERD. Our aim was to evaluate changes in symptoms, endoscopic findings, bolus passage and esophageal function in patients after primary gastric bypass surgery as compared to patients converted from gastric banding to gastric bypass.

Methods

Obese patients scheduled for laparoscopic Roux-en-Y gastric bypass (naïve-to-bypass) and patients who previously underwent gastric banding and were considered for conversion from gastric banding to gastric bypass (band-to-bypass) were included. Patients rated esophageal and epigastric symptoms (100 point VAS) and underwent upper endoscopy, impedance–manometry, and modified “timed barium swallow” before/after surgery.

Results

Data from 66 naïve-to-bypass patients (51/66, 77 % females, mean age 41.2 ± 11.1 years) and 68 band-to-bypass patients (53/68, 78 % females, mean age 43.8 ± 10.0 years) were available for analysis. Esophageal symptoms, esophagitis, esophageal motility abnormalities and impaired esophageal bolus transit were more common in patients that underwent gastric banding compared to those that underwent gastric bypass. The majority of symptoms, lesions and abnormalities induced by gastric banding were decreased by conversion to gastric bypass. Esophagitis was present in 28/68 (41 %) and 13/47 (28 %) patients in the band-to-bypass group, pre- versus postoperatively, respectively, (p < 0.05). The percentage of swallows with normal bolus transit increased following transformation from gastric band to gastric bypass (57.9 ± 4.1 and 83.6 ± 3.4 %, respectively, p < 0.01).

Conclusions

From an esophageal perspective, gastric bypass surgery induces less motility disorders and esophageal symptoms and should be therefore favored over gastric banding in difficult to treat obese patients at risk of repeated bariatric surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

BTT:

Bolus transit time

DEA:

Distal esophageal amplitude

EFT:

Esophageal function testing

GERD:

Gastroesophageal reflux disease

GI:

Gastrointestinal

HPZ:

High-pressure zone

LA:

Los Angeles classification

LASGB:

Laparoscopic adjustable silicone gastric banding

LES:

Lower esophageal sphincter

LRYGBP:

Laparoscopic Roux-en-Y gastric bypass

LVBG:

Laparoscopic vertical banded gastroplasty

MII-EM:

Combined impedance–manometry

PPIs:

Proton pump inhibitors

References

  1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM (2006) Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295:1549–1555

    Article  CAS  PubMed  Google Scholar 

  2. El-Serag HB, Graham DY, Satia JA, Rabeneck L (2005) Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol 100:1243–1250

    Article  PubMed  Google Scholar 

  3. Jacobson BC, Somers SC, Fuchs CS, Kelly CP, Camargo CA Jr (2006) Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med 354:2340–2348

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Vaezi MF, Baker ME, Achkar E, Richter JE (2002) Timed barium oesophagram: better predictor of longterm success after pneumatic dilation in achalasia than symptom assessment. Gut 50:765–770

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Spechler SJ, Castell DO (2001) Classification of oesophageal motility abnormalities. Gut 49:145–151

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Tutuian R, Vela MF, Balaji NS, Wise JL, Murray JA, Peters JH, Shay SS, Castell DO (2003) Esophageal function testing with combined multichannel intraluminal impedance and manometry: multicenter study in healthy volunteers. Clin Gastroenterol Hepatol 1:174–182

    Article  PubMed  Google Scholar 

  7. Naef M, Mouton WG, Naef U, van der Weg B, Maddern GJ, Wagner HE (2011) Esophageal dysmotility disorders after laparoscopic gastric banding—an underestimated complication. Ann Surg 253:285–290

    Article  PubMed  Google Scholar 

  8. de Jong JR, Besselink MG, van Ramshorst B, Gooszen HG, Smout AJ (2010) Effects of adjustable gastric banding on gastroesophageal reflux and esophageal motility: a systematic review. Obes Rev 11:297–305

    Article  PubMed  Google Scholar 

  9. Dixon JB, O’Brien PE (1999) Gastroesophageal reflux in obesity: the effect of lap-band placement. Obes Surg 9:527–531

    Article  CAS  PubMed  Google Scholar 

  10. Rebecchi F, Rocchietto S, Giaccone C, Talha A, Morino M (2011) Gastroesophageal reflux disease and esophageal motility in morbidly obese patients submitted to laparoscopic adjustable silicone gastric banding or laparoscopic vertical banded gastroplasty. Surg Endosc 25:795–803

    Article  PubMed  Google Scholar 

  11. Perry Y, Courcoulas AP, Fernando HC, Buenaventura PO, McCaughan JS, Luketich JD (2004) Laparoscopic Roux-en-Y gastric bypass for recalcitrant gastroesophageal reflux disease in morbidly obese patients. JSLS 8:19–23

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We like to specifically acknowledge the hard work of our study nurse Patrizia Künzler with regard to patient and data management.

Funding

This study was funded by the Research Council of the University of Zurich and registered at ClinicalTrials.gov (NCT00680030).

Author’s contribution

Jan Borovicka and Radu Tutuian equally contributed to the study design, planned the study protocol. Both of them also performed data analysis and wrote the manuscript. Radu Tutuian obtained funding from the study from the Research Foundation of the University Hospital of Zurich/University of Zurich. Claudia Krieger-Gruebel, Boudewijn van der Weg, Michael Christian Sulz, and Philipp Bisang performed the procedures and analyzed the data. Martin Thurnheer performed all gastric bypass surgeries. Bernd Schultes and Jean-Pierre Gutzwiler performed data analysis and approved the final draft. Daniel Pohl wrote the study protocol. Michael Fried and Christa Meyenberger critically reviewed the analysis and approved the final draft. All authors have read and approved the final version of the manuscript.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Kantonsspital St. Gallen, 9001, St. Gallen, Switzerland

    Jan Borovicka, Claudia Krieger-Grübel, Boudewijn van der Weg, Michael Christian Sulz & Christa Meyenberger

  2. Hirslanden Clinic, 9016, St. Gallen, Switzerland

    Martin Thurnheer, Bernd Schultes & Philipp Bisang

  3. Private Gastroenterology Practice, 8800, Thalwil, Switzerland

    Jean-Pierre Gutzwiler

  4. Division of Gastroenterology, University Hospital Zurich, 8091, Zurich, Switzerland

    Daniel Pohl, Michael Fried & Radu Tutuian

  5. Division of Gastroenterology, University Clinics for Visceral Surgery and Medicine, Bern University Hospital, 3010, Bern, Switzerland

    Radu Tutuian

Authors
  1. Jan Borovicka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claudia Krieger-Grübel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Boudewijn van der Weg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Thurnheer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernd Schultes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael Christian Sulz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean-Pierre Gutzwiler
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Philipp Bisang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Daniel Pohl
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Michael Fried
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Christa Meyenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Radu Tutuian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Radu Tutuian.

Ethics declarations

Disclosures

Radu Tutuian contributes to educational programs of Sandhill Scientific Inc. and Medical Measurements Systems (MMS) International. Travel support and speaker honoraria were received from Allmiral, AbbVie, Abbott, UCB in the past 2 years. Jan Borovicka, Claudia Krieger-Gruebel, Boudewijn van der Weg, Michael Christian Sulz, Philipp Bisang, Martin Thurnheer, Bernd Schultes, Jean-Pierre Gutzwiler, Daniel Pohl, Michael Fried, and Christa Meyenberger have no conflicts of interests that are relevant to the manuscript.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Borovicka, J., Krieger-Grübel, C., van der Weg, B. et al. Effect of morbid obesity, gastric banding and gastric bypass on esophageal symptoms, mucosa and function. Surg Endosc 31, 552–560 (2017). https://doi.org/10.1007/s00464-016-4996-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-4996-5

Keywords

Search

Navigation