Upper gastrointestinal investigations before gastric banding.
BACKGROUND
Long-term complications after laparoscopic gastric banding (LAGB) are frequent, leading to reoperations for a substantial number of patients. It is not known whether esophageal motility or the lower esophageal sphincter (LES) play a role in the development of complications. The results of preoperative upper gastrointestinal (GI) testing were compared with outcome after LAGB.


METHODS
Before LAGB, 68 bariatric patients had esophageal manometry, endoscopy, and pH monitoring. For 61 of these patients (90% follow-up rate), the differences in weight loss, complications, and reoperation rate were retrospectively compared.


RESULTS
Of these patients, 8.2% had a nonspecific motility disorder of the esophagus, 44.3% had an incompetent sphincter shown by manometry, and 17.5% had acid reflux shown by pH monitoring. Endoscopic evaluation showed esophagitis in 10.3% and hiatal hernia in 33.8% of the patients. Abnormal pH monitoring and endoscopic findings were not predictive for the long-term outcome or complications. The presence of an incompetent LES led to reoperation for a greater number of patients (44.4 vs. 14.7%; p = 0.01), especially if the band was placed using the pars flaccida technique.


CONCLUSIONS
Endoscopy and pH monitoring do not predict outcome for gastric banding and therefore have no relevance in the selection of patients for gastric banding. Patients with an incompetent LES shown by manometry had a higher reoperation rate. If this finding can be confirmed, patients with LES incompetence may need another intervention.
Bueter
Marco
M
Department of Surgery, University of Würzburg, Würzburg, Germany. m.bueter@imperial.ac.uk
Thalheimer
Andreas
A
le Roux
Carel W
CW
Wierlemann
Alexander
A
Seyfried
Florian
F
Fein
Martin
M
D000293:Adolescent; D000328:Adult; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D049630:Esophageal Sphincter, Lower / Q000473:pathology / Q000503:physiopathology; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult