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Diagnosis and treatment of megaesophagus after adjustable gastric banding for morbid obesity.
Surg Obes Relat Dis 2009 Mar-Apr; 5(2):156-9SO

Abstract

BACKGROUND

Laparoscopic adjustable gastric banding (LAGB) can impair esophageal peristalsis and can also cause a lack of relaxation of the lower esophageal sphincter, possibly leading to esophageal dilation. The aim of the present study was to determine the incidence of megaesophagus, the role of preoperative manometry in predicting its occurrence, and the management of megaesophagus after gastric banding in the setting of a research clinic.

METHODS

We performed a retrospective review of a prospectively collected database. A total of 257 patients underwent LAGB from January 2002 to December 2006. The incidence of megaesophagus, its relationship to the preoperative esophageal manometry and upper gastrointestinal series findings, and the treatment of patients with this complication were analyzed.

RESULTS

Of the 257 patients, 5 (1.9%) presented with megaesophagus after gastric banding. The mean interval to development was 32 months (range 24-36). The diagnosis was made using the symptoms, signs, and upper gastrointestinal series findings. The preoperative esophageal manometry findings were normal in 4 (80%) of these 5 patients, and 1 patient (20%) had a nonspecific motility disorder. The mean age was 54.5 years (range 30-76). The mean preoperative weight was 127.1 kg (range 112.7-145.9), and the body mass index was 43.2 kg/m2 (range 41-49). In all cases, the management of megaesophagus was gastric band removal. All the patients improved partially after band deflation but required band removal because of continued symptoms.

CONCLUSION

Megaesophagus is a possible late complication after LAGB. The preoperative manometry results cannot predict for its occurrence. The management of megaesophagus caused by LAGB requires, in most cases, band removal.

Authors+Show Affiliations

Bariatric and Metabolic Institute, Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.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)

Comparative Study
Journal Article

Language

eng

PubMed ID

19250879

Citation

Arias, I Enrique, et al. "Diagnosis and Treatment of Megaesophagus After Adjustable Gastric Banding for Morbid Obesity." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 5, no. 2, 2009, pp. 156-9.
Arias IE, Radulescu M, Stiegeler R, et al. Diagnosis and treatment of megaesophagus after adjustable gastric banding for morbid obesity. Surg Obes Relat Dis. 2009;5(2):156-9.
Arias, I. E., Radulescu, M., Stiegeler, R., Singh, J. P., Martinez, P., Ramirez, A., ... Rosenthal, R. J. (2009). Diagnosis and treatment of megaesophagus after adjustable gastric banding for morbid obesity. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 5(2), pp. 156-9. doi:10.1016/j.soard.2008.11.007.
Arias IE, et al. Diagnosis and Treatment of Megaesophagus After Adjustable Gastric Banding for Morbid Obesity. Surg Obes Relat Dis. 2009;5(2):156-9. PubMed PMID: 19250879.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis and treatment of megaesophagus after adjustable gastric banding for morbid obesity. AU - Arias,I Enrique, AU - Radulescu,Marin, AU - Stiegeler,Rieke, AU - Singh,J P, AU - Martinez,Pedro, AU - Ramirez,Alexander, AU - Szomstein,Samuel, AU - Rosenthal,Raul J, Y1 - 2008/11/21/ PY - 2008/05/29/received PY - 2008/11/06/revised PY - 2008/11/06/accepted PY - 2009/3/3/entrez PY - 2009/3/3/pubmed PY - 2009/6/10/medline SP - 156 EP - 9 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 5 IS - 2 N2 - BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) can impair esophageal peristalsis and can also cause a lack of relaxation of the lower esophageal sphincter, possibly leading to esophageal dilation. The aim of the present study was to determine the incidence of megaesophagus, the role of preoperative manometry in predicting its occurrence, and the management of megaesophagus after gastric banding in the setting of a research clinic. METHODS: We performed a retrospective review of a prospectively collected database. A total of 257 patients underwent LAGB from January 2002 to December 2006. The incidence of megaesophagus, its relationship to the preoperative esophageal manometry and upper gastrointestinal series findings, and the treatment of patients with this complication were analyzed. RESULTS: Of the 257 patients, 5 (1.9%) presented with megaesophagus after gastric banding. The mean interval to development was 32 months (range 24-36). The diagnosis was made using the symptoms, signs, and upper gastrointestinal series findings. The preoperative esophageal manometry findings were normal in 4 (80%) of these 5 patients, and 1 patient (20%) had a nonspecific motility disorder. The mean age was 54.5 years (range 30-76). The mean preoperative weight was 127.1 kg (range 112.7-145.9), and the body mass index was 43.2 kg/m2 (range 41-49). In all cases, the management of megaesophagus was gastric band removal. All the patients improved partially after band deflation but required band removal because of continued symptoms. CONCLUSION: Megaesophagus is a possible late complication after LAGB. The preoperative manometry results cannot predict for its occurrence. The management of megaesophagus caused by LAGB requires, in most cases, band removal. SN - 1550-7289 UR - https://www.unboundmedicine.com/medline/citation/19250879/Diagnosis_and_treatment_of_megaesophagus_after_adjustable_gastric_banding_for_morbid_obesity_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(08)00831-9 DB - PRIME DP - Unbound Medicine ER -