Effect of morbid obesity, gastric banding and gastric bypass on esophageal symptoms, mucosa and function

Jan Borovicka, Claudia Krieger-Grübel, Boudewijn van der Weg, Martin Thurnheer, Bernd Schultes, Michael Christian Sulz, Jean-Pierre Gutzwiler, Philipp Bisang, Daniel Pohl, Michael Fried, Christa Meyenberger, Radu Tutuian, Jan Borovicka, Claudia Krieger-Grübel, Boudewijn van der Weg, Martin Thurnheer, Bernd Schultes, Michael Christian Sulz, Jean-Pierre Gutzwiler, Philipp Bisang, Daniel Pohl, Michael Fried, Christa Meyenberger, Radu Tutuian

Abstract

Background: Obesity and gastroesophageal reflux disease (GERD) are commonly associated diseases. Bariatric surgery has been shown to have various impacts on esophageal function and GERD. Our aim was to evaluate changes in symptoms, endoscopic findings, bolus passage and esophageal function in patients after primary gastric bypass surgery as compared to patients converted from gastric banding to gastric bypass.

Methods: Obese patients scheduled for laparoscopic Roux-en-Y gastric bypass (naïve-to-bypass) and patients who previously underwent gastric banding and were considered for conversion from gastric banding to gastric bypass (band-to-bypass) were included. Patients rated esophageal and epigastric symptoms (100 point VAS) and underwent upper endoscopy, impedance-manometry, and modified "timed barium swallow" before/after surgery.

Results: Data from 66 naïve-to-bypass patients (51/66, 77 % females, mean age 41.2 ± 11.1 years) and 68 band-to-bypass patients (53/68, 78 % females, mean age 43.8 ± 10.0 years) were available for analysis. Esophageal symptoms, esophagitis, esophageal motility abnormalities and impaired esophageal bolus transit were more common in patients that underwent gastric banding compared to those that underwent gastric bypass. The majority of symptoms, lesions and abnormalities induced by gastric banding were decreased by conversion to gastric bypass. Esophagitis was present in 28/68 (41 %) and 13/47 (28 %) patients in the band-to-bypass group, pre- versus postoperatively, respectively, (p < 0.05). The percentage of swallows with normal bolus transit increased following transformation from gastric band to gastric bypass (57.9 ± 4.1 and 83.6 ± 3.4 %, respectively, p < 0.01).

Conclusions: From an esophageal perspective, gastric bypass surgery induces less motility disorders and esophageal symptoms and should be therefore favored over gastric banding in difficult to treat obese patients at risk of repeated bariatric surgery.

Trial registration: ClinicalTrials.gov NCT00680030.

Keywords: Bariatric surgery; Endoscopy; Impedance–manometry; Obesity.

References

    1. JAMA. 2006 Apr 5;295(13):1549-55
    1. Clin Gastroenterol Hepatol. 2003 May;1(3):174-82
    1. Am J Gastroenterol. 2005 Jun;100(6):1243-50
    1. Gut. 2002 Jun;50(6):765-70
    1. N Engl J Med. 2006 Jun 1;354(22):2340-8
    1. JSLS. 2004 Jan-Mar;8(1):19-23
    1. Ann Surg. 2011 Feb;253(2):285-90
    1. Gut. 2001 Jul;49(1):145-51
    1. Obes Rev. 2010 Apr;11(4):297-305
    1. Surg Endosc. 2011 Mar;25(3):795-803
    1. Obes Surg. 1999 Dec;9(6):527-31

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren