title: High-resolution Impedance Manometry after Sleeve Gastrectomy: Increased Intragastric Pressure and Reflux are Frequent Events.
abstract: Sleeve gastrectomy (SG) is gaining ground in the field of bariatric surgery. Data are scarce on its impact on esophagogastric physiology. Our aim was to evaluate the impact of SG on esophagogastric motility with high-resolution impedance manometry (HRIM) and to assess the usefulness of HRIM in patients with upper gastrointestinal (GI) symptoms after SG.
  
  
  
  A retrospective analysis of 53 cases of HRIM performed after SG was conducted. Upper GI symptoms at the time of HRIM were scored. HRIM was analyzed according to the Chicago classification v3.0. A special attention was devoted to the occurrence of increased intragastric pressure (IIGP) after water swallows and reflux episodes as detected with impedance. A measurement of sleeve volume and diameter was performed with CT scan in a subgroup of patients.
  
  
  
  IIGP occurred very frequently in patients after SG (77 %) and was not associated with any upper GI symptoms, specific esophageal manometric profile, or impedance reflux. Impedance reflux episodes were also frequently observed after SG (52 %): they were significantly associated with gastroesophageal reflux (GER) symptoms and ineffective esophageal motility. The sleeve volume and diameters were also significantly smaller in patients with impedance reflux episodes (p < 0.01).
  
  
  
  SG significantly modified esophagogastric motility. IIGP is frequent, not correlated to symptoms, and should be regarded as a HRIM marker of SG. Impedance reflux episodes were also frequent, associated with GER symptoms and esophageal dysmotility. HRIM may thus have a clinical impact on the management of patients with upper GI symptoms after SG.
authors.affiliation: Pavillon L, Hospital E. Herriot, 69437, Lyon, Cedex 03, France. francois.mion@chu-lyon.fr.
authors.forename: François
authors.initials: F
authors.lastname: Mion
authors.affiliation: Division of General and Bariatric Surgery, University of Naples S.U.N, Caserta, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
authors.affiliation: Hospices Civils de Lyon, Hospital E. Herriot, Digestive Physiology, Lyon, & University Lyon I, Lyon, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Garros
authors.affiliation: Gastroenterology, University of Padova, Padova, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Savarino
authors.affiliation: Hospices Civils de Lyon, Hospital E. Herriot, Digestive and Bariatric Surgery, Lyon, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Pelascini
authors.affiliation: Hospices Civils de Lyon, Hospital E. Herriot, Digestive and Bariatric Surgery, Lyon, France.
authors.forename: Maud
authors.initials: M
authors.lastname: Robert
authors.affiliation: Hospices Civils de Lyon, Hospital E. Herriot, Digestive and Bariatric Surgery, Lyon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Poncet
authors.affiliation: Hospices Civils de Lyon, Radiology Department, Lyon, & University Lyon 1, Lyon, France.
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Valette
authors.affiliation: Hospices Civils de Lyon, Hospital E. Herriot, Digestive Physiology, Lyon, & University Lyon I, Lyon, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Marjoux
authors.affiliation: Division of General and Bariatric Surgery, University of Naples S.U.N, Caserta, Italy.
authors.forename: Ludovico
authors.initials: L
authors.lastname: Docimo
authors.affiliation: Hospices Civils de Lyon, Hospital E. Herriot, Digestive Physiology, Lyon, & University Lyon I, Lyon, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Roman
mesh_terms: D000328:Adult; D017097:Electric Impedance; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D005746:Gastric Emptying; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011312:Pressure; D012189:Retrospective Studies; D013270:Stomach / Q000503:physiopathology*
keywords: Bariatric surgery; Gastroesophageal reflux; Hiatal hernia; Obesity