title: Diagnosis and treatment of megaesophagus after adjustable gastric banding for morbid obesity.
abstract: BACKGROUND
  Laparoscopic adjustable gastric banding (LAGB) can impair esophageal peristalsis and can also cause a lack of relaxation of the lower esophageal sphincter, possibly leading to esophageal dilation. The aim of the present study was to determine the incidence of megaesophagus, the role of preoperative manometry in predicting its occurrence, and the management of megaesophagus after gastric banding in the setting of a research clinic.
  
  
  METHODS
  We performed a retrospective review of a prospectively collected database. A total of 257 patients underwent LAGB from January 2002 to December 2006. The incidence of megaesophagus, its relationship to the preoperative esophageal manometry and upper gastrointestinal series findings, and the treatment of patients with this complication were analyzed.
  
  
  RESULTS
  Of the 257 patients, 5 (1.9%) presented with megaesophagus after gastric banding. The mean interval to development was 32 months (range 24-36). The diagnosis was made using the symptoms, signs, and upper gastrointestinal series findings. The preoperative esophageal manometry findings were normal in 4 (80%) of these 5 patients, and 1 patient (20%) had a nonspecific motility disorder. The mean age was 54.5 years (range 30-76). The mean preoperative weight was 127.1 kg (range 112.7-145.9), and the body mass index was 43.2 kg/m2 (range 41-49). In all cases, the management of megaesophagus was gastric band removal. All the patients improved partially after band deflation but required band removal because of continued symptoms.
  
  
  CONCLUSIONS
  Megaesophagus is a possible late complication after LAGB. The preoperative manometry results cannot predict for its occurrence. The management of megaesophagus caused by LAGB requires, in most cases, band removal.
authors.affiliation: Bariatric and Metabolic Institute, Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.
authors.forename: I Enrique
authors.initials: IE
authors.lastname: Arias
authors.forename: Marin
authors.initials: M
authors.lastname: Radulescu
authors.forename: Rieke
authors.initials: R
authors.lastname: Stiegeler
authors.forename: J P
authors.initials: JP
authors.lastname: Singh
authors.forename: Pedro
authors.initials: P
authors.lastname: Martinez
authors.forename: Alexander
authors.initials: A
authors.lastname: Ramirez
authors.forename: Samuel
authors.initials: S
authors.lastname: Szomstein
authors.forename: Raul J
authors.initials: RJ
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D000368:Aged; D020878:Device Removal / Q000379:methods*; D004108:Dilatation, Pathologic; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D004947:Esophagus / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D011312:Pressure; D012189:Retrospective Studies; D016896:Treatment Outcome