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Esophageal motor responses to increasing adjustment of an implanted gastric band
Author(s) -
Burgerhart J. S.,
Aarts E. O.,
Meeberg P. C.,
Berends F. J.,
Siersema P. D.,
Smout A. J. P. M.
Publication year - 2013
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.12113
Subject(s) - adjustable gastric band , high resolution manometry , medicine , esophagus , peristalsis , gastroenterology , weight loss , morbid obesity , obesity , achalasia
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. Key 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 & Inferences 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.