Gastric banding interferes with esophageal motility and gastroesophageal reflux.
BACKGROUND
Gastroesophageal reflux and progressive esophageal dilatation can develop after gastric banding (GB).


OBJECTIVE
Gastric banding may interfere with esophageal motility, enhance reflux, or promote esophageal dilatation.


METHODS
Before-after trial in patients undergoing GB.


METHODS
University teaching hospital.


METHODS
Between January 1999 and August 2002, 43 patients undergoing laparoscopic GB for morbid obesity underwent upper gastrointestinal endoscopy, 24-hour pH monitoring, and stationary esophageal manometry before GB and between 6 and 18 months postoperatively.


METHODS
Reflux symptoms, endoscopic esophagitis, pressures measured at manometry, esophageal acid exposure.


RESULTS
There was no difference in the prevalence of reflux symptoms or esophagitis before and after GB. The lower esophageal sphincter was unaffected by surgery, but contractions in the lower esophagus weakened after GB, in correlation with preoperative values. There was a trend toward more postoperative nonspecific motility disorders. Esophageal acid exposure tended to decrease after GB, with fewer reflux episodes. A few patients developed massive postoperative reflux. There was no clear correlation between preoperative testing and postoperative esophageal acid exposure, although patients with abnormal preoperative acid exposure tended to maintain high values after GB.


CONCLUSIONS
Postoperative esophageal dysmotility and gastroesophageal reflux are not uncommon after GB. Preoperative testing should be done routinely. Low amplitude of contraction in the lower esophagus and increased esophageal acid exposure should be regarded as contraindications to GB. Patients with such findings should be offered an alternative procedure, such as Roux-en-Y gastric bypass.
Suter
Michel
M
Department of Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. michelsuter@netplus.ch
Dorta
Gian
G
Giusti
Vittorio
V
Calmes
Jean-Marie
JM
D000328:Adult; D017677:Age Distribution; D015992:Body Mass Index; D015154:Esophageal Motility Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005745:Gastric Acidity Determination; D015905:Gastric Balloon; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric