title: Lap-band impact on the function of the esophagus.
abstract: BACKGROUND
  The laparoscopic adjustable gastric band (LAGB) has been widely used to treat morbid obesity. There is conflicting data on its long-term effect on esophageal function. Our aim was to assess the long-term impact of the LAGB on esophageal motility and pH-metry in patients who had LAGB who had normal and abnormal esophageal function at baseline.
  
  
  METHODS
  Consecutive patients referred for bariatric surgery were prospectively enrolled. A detailed medical history was obtained, and esophageal manometric and 24-h pH evaluations were performed in standard fashion preoperatively and 6 and 12 months postoperatively; patients served as their own controls.
  
  
  RESULTS
  Twenty-two patients completed manometric evaluation. Ten patients had normal manometric parameters at baseline; at 6 months, mean lower esophageal sphincter (LES) residual pressure increased significantly from baseline (3.9 +/- 2 vs. 8.9 +/- 4 mmHg, p = 0.014). At 12 months, the mean peristaltic wave duration increased from 3.6 +/- 1 at baseline to 6.8 +/- 2 s, p = 0.025 and wave amplitude decreased during the same period (98.7 +/- 22 vs. 52.3 +/- 24, p = 0.013). LES pressure and percent peristalsis did not differ significantly pre- and post-LAGB. Twelve patients had one or more abnormal manometric findings at baseline; at 12 months, LES pressure in these 12 patients decreased significantly (31.1 +/- 10 vs 23.6 +/- 7, p = 0.011) and wave amplitude was significantly reduced (125.9 +/- 117 vs 103 +/- 107, p = 0.039). LES residual pressure did not change significantly pre- and post-LAGB. Twenty-two individuals were evaluated for impact of Lap-Band on esophageal acid exposure. Sixteen of these patients had normal esophageal pH-metry values at baseline and had no significant changes in 12 months in any pH-metry measurement. Six patients had abnormal pH-metry values at baseline. Among these patients, time with pH < 4.0 and Johnson/DeMeester score did not change significantly during follow-up. There was a significant decrease in the number of reflux episodes from baseline to 6 months (159 +/- 48 vs. 81 +/- 61, p = 0.016).
  
  
  CONCLUSIONS
  Abnormal manometric findings are frequently encountered post-LAGB. Increases in LES residual pressure and peristaltic wave duration were the most significant changes. LAGB is not associated with an increase in total esophageal acidification time. Further evaluation of the clinical significance of manometric abnormalities is warranted.
authors.affiliation: Division of Gastroenterology, Department of Medicine, New York University School of Medicine, Bellevue Hospital Center, 462 First Avenue Room 10E1, New York, NY, 10016, USA. gamagz01@med.nyu.edu
authors.forename: Zoi
authors.initials: Z
authors.lastname: Gamagaris
authors.forename: Carlie
authors.initials: C
authors.lastname: Patterson
authors.forename: Verity
authors.initials: V
authors.lastname: Schaye
authors.forename: Fritz
authors.initials: F
authors.lastname: Francois
authors.forename: Morris
authors.initials: M
authors.lastname: Traube
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Fielding
authors.forename: George A
authors.initials: GA
authors.lastname: Fielding
authors.forename: Allison Heekoung
authors.initials: AH
authors.lastname: Youn
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Weinshel
mesh_terms: D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D015391:Gastroplasty / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008365:Manometry; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D010865:Pilot Projects; D016896:Treatment Outcome; D015431:Weight Loss