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Prevalent esophageal body motility disorders underlie aggravation of GERD symptoms in morbidly obese patients following adjustable gastric banding.
Arch Surg 2006; 141(3):247-51AS

Abstract

HYPOTHESIS

Preexisting gastroesophageal reflux disease (GERD) and esophageal motility disorders may affect the outcome of laparoscopic adjustable gastric banding (AGB).

DESIGN

Prospective cohort study.

SETTING

Tertiary referral center.

PATIENTS

Between January 1, 1996, and December 31, 2002, AGB procedures were performed in 587 patients (mean body mass index, 46.7 [calculated as weight in kilograms divided by the square of height in meters]). The study population was composed of patients with preoperative GERD (assessed by a symptom-score questionnaire) and was divided into group 1 (those with preoperative GERD symptoms only) and group 2 (those with preoperative and postoperative GERD symptoms).

INTERVENTIONS

Laparoscopic AGB was performed according to the pars-flaccida technique.

MAIN OUTCOME MEASURES

All patients underwent preoperative and annual postoperative symptom scoring, endoscopy, esophageal barium swallow tests, esophageal manometry, and 24-hour pH monitoring.

RESULTS

Mean follow-up time was 33 months (range, 12-49 months). A total of 164 patients (27.9%) were diagnosed as having preoperative GERD symptoms. In 112 (68.3%) of these patients GERD symptoms vanished postoperatively (group 1), whereas 52 patients (31.7%) remained symptomatic after undergoing laparoscopic AGB implantation (group 2). Preoperatively, group 2 patients showed significantly poorer esophageal body motility compared with group 1 patients (20.8% vs 12.8% defective propagations; P = .007). In group 2 the mean symptom scores for dysphagia (0.4 vs 0.9) and regurgitation (0.6 vs 1.4) deteriorated significantly following laparoscopic AGB implantation, respectively. Eighteen patients (34.6%) in group 2 developed esophageal dilatation.

CONCLUSIONS

Adjustable gastric banding provides a sufficient antireflux barrier in most of the obese patients with GERD. However, in patients with preoperatively defective esophageal body motility, AGB may aggravate GERD symptoms and esophageal dilatation. Alternative bariatric surgical procedures should be considered in these patients.

Authors+Show Affiliations

Department of General and Transplant Surgery and Radiology, Medical University Innsbruck, Innsbruck, Austria.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16549689

Citation

Klaus, Alexander, et al. "Prevalent Esophageal Body Motility Disorders Underlie Aggravation of GERD Symptoms in Morbidly Obese Patients Following Adjustable Gastric Banding." Archives of Surgery (Chicago, Ill. : 1960), vol. 141, no. 3, 2006, pp. 247-51.
Klaus A, Gruber I, Wetscher G, et al. Prevalent esophageal body motility disorders underlie aggravation of GERD symptoms in morbidly obese patients following adjustable gastric banding. Arch Surg. 2006;141(3):247-51.
Klaus, A., Gruber, I., Wetscher, G., Nehoda, H., Aigner, F., Peer, R., ... Weiss, H. (2006). Prevalent esophageal body motility disorders underlie aggravation of GERD symptoms in morbidly obese patients following adjustable gastric banding. Archives of Surgery (Chicago, Ill. : 1960), 141(3), pp. 247-51.
Klaus A, et al. Prevalent Esophageal Body Motility Disorders Underlie Aggravation of GERD Symptoms in Morbidly Obese Patients Following Adjustable Gastric Banding. Arch Surg. 2006;141(3):247-51. PubMed PMID: 16549689.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalent esophageal body motility disorders underlie aggravation of GERD symptoms in morbidly obese patients following adjustable gastric banding. AU - Klaus,Alexander, AU - Gruber,Ingrid, AU - Wetscher,Gerold, AU - Nehoda,Hermann, AU - Aigner,Franz, AU - Peer,Regina, AU - Margreiter,Raimund, AU - Weiss,Helmut, PY - 2006/3/22/pubmed PY - 2006/4/21/medline PY - 2006/3/22/entrez SP - 247 EP - 51 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 141 IS - 3 N2 - HYPOTHESIS: Preexisting gastroesophageal reflux disease (GERD) and esophageal motility disorders may affect the outcome of laparoscopic adjustable gastric banding (AGB). DESIGN: Prospective cohort study. SETTING: Tertiary referral center. PATIENTS: Between January 1, 1996, and December 31, 2002, AGB procedures were performed in 587 patients (mean body mass index, 46.7 [calculated as weight in kilograms divided by the square of height in meters]). The study population was composed of patients with preoperative GERD (assessed by a symptom-score questionnaire) and was divided into group 1 (those with preoperative GERD symptoms only) and group 2 (those with preoperative and postoperative GERD symptoms). INTERVENTIONS: Laparoscopic AGB was performed according to the pars-flaccida technique. MAIN OUTCOME MEASURES: All patients underwent preoperative and annual postoperative symptom scoring, endoscopy, esophageal barium swallow tests, esophageal manometry, and 24-hour pH monitoring. RESULTS: Mean follow-up time was 33 months (range, 12-49 months). A total of 164 patients (27.9%) were diagnosed as having preoperative GERD symptoms. In 112 (68.3%) of these patients GERD symptoms vanished postoperatively (group 1), whereas 52 patients (31.7%) remained symptomatic after undergoing laparoscopic AGB implantation (group 2). Preoperatively, group 2 patients showed significantly poorer esophageal body motility compared with group 1 patients (20.8% vs 12.8% defective propagations; P = .007). In group 2 the mean symptom scores for dysphagia (0.4 vs 0.9) and regurgitation (0.6 vs 1.4) deteriorated significantly following laparoscopic AGB implantation, respectively. Eighteen patients (34.6%) in group 2 developed esophageal dilatation. CONCLUSIONS: Adjustable gastric banding provides a sufficient antireflux barrier in most of the obese patients with GERD. However, in patients with preoperatively defective esophageal body motility, AGB may aggravate GERD symptoms and esophageal dilatation. Alternative bariatric surgical procedures should be considered in these patients. SN - 0004-0010 UR - https://www.unboundmedicine.com/medline/citation/16549689/Prevalent_esophageal_body_motility_disorders_underlie_aggravation_of_GERD_symptoms_in_morbidly_obese_patients_following_adjustable_gastric_banding_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.141.3.247 DB - PRIME DP - Unbound Medicine ER -