title: Esophageal motor responses to increasing adjustment of an implanted gastric band.
abstract: BACKGROUND
  The adjustable gastric band is an effective surgical treatment to induce weight loss in patients with morbid obesity. We aimed to assess the effects of band placement and stepwise adjustment on esophageal motility, using high-resolution manometry (HRM).
  
  
  METHODS
  Patients underwent esophageal HRM before and 6 weeks after gastric band placement. During postoperative assessment, HRM was combined with intraband pressure measurement at increasing filling volumes.
  
  
  RESULTS
  In total, 15 patients were studied. Mean DCI (±SD) decreased from 1085.3 ± 1064.1 mmHg s(-1)  cm(-1) before to 507 ± 347.2 mmHg s(-1)  cm(-1) (P = 0.015) after band placement, mean IBP from 10.7 ± 1.7 mmHg to 7.7 ± 1.6 mmHg (P = 0.01). Stepwise band adjustment from 1 to 8 mL had an immediate and profound effect on swallow-induced esophageal contractions: DCI increased from 766 ± 590.4 to 7231 ± 6298.1 mmHg s(-1)  cm(-1) , IBP from 4.3 mmHg to 31.1 ± 17.3 mmHg, and intraband pressure increased from -109.1 ± 60.6 mmHg to 150.2 ± 65 mmHg. During band filling with volumes >5 mL, upward displacement of the LES was observed, indicative of shortening of the esophagus; the distance between the UES and LES decreased from 23.5 ± 1.3 cm at 0 mL to 19.9 ± 2 cm at 8 mL.
  
  
  CONCLUSIONS
  Stepwise gastric band adjustment leads to immediate enforcement of esophageal peristalsis associated with an increase in intrabolus pressure and with pronounced esophageal shortening. Subjects who lack these responses to outflow obstruction may be more prone to dysphagia after band placement.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. J.S. Burgerhart@umcutrecht.nl
authors.forename: J S
authors.initials: JS
authors.lastname: Burgerhart
authors.forename: E O
authors.initials: EO
authors.lastname: Aarts
authors.forename: P C
authors.initials: PC
authors.lastname: van de Meeberg
authors.forename: F J
authors.initials: FJ
authors.lastname: Berends
authors.forename: P D
authors.initials: PD
authors.lastname: Siersema
authors.forename: A J P M
authors.initials: AJ
authors.lastname: Smout
mesh_terms: D000328:Adult; D049630:Esophageal Sphincter, Lower / Q000502:physiology; D049631:Esophageal Sphincter, Upper / Q000502:physiology; D004947:Esophagus / Q000502:physiology*; D005260:Female; D015391:Gastroplasty; D006801:Humans; D008297:Male; D008365:Manometry; D009765:Obesity / Q000601:surgery*; D010528:Peristalsis / Q000502:physiology*