Search

Background: This study investigates multiple rapid swallows during high-resolution esophageal manometry (HREM) as an indicator of esophageal dysmotility following bariatric surgery. Gastrointestinal complications, including esophageal dysfunction, are common after bariatric surgery, and predictive markers are lacking., Methods: Retrospective analysis of adult patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2013 and 2023 and were subsequently evaluated by HREM. Contractile reserve (CR) and breakthrough contractions were assessed during MRS and HREM studies assessed by the Chicago Classification version 4.0., Results: Breakthrough contractions were found in 52.2% of patients undergoing HREM during multiple rapid swallows (MRS), including 70% of patients classified as normal manometry. Presence of breakthrough contractions correlated with greater DCI (1039 vs. 446 mmhg-s-cm, p = 0.05), and was more common after SG compared to RYGB (58.3% vs. 41.7%, p = 0.089) and in proton pump inhibitor users (100% vs. 72.7%, p = 0.093). Contractile reserve was observed in 56.5% of patients, similar to non-bariatric cohorts., Conclusions: Breakthrough contractions are frequent in post-bariatric patients, even with normal manometry, suggesting early esophageal dysfunction. Sleeve gastrectomy patients showed a higher trend of these contractions, potentially due to increased intragastric pressure. Further studies are needed to understand long-term implications., Competing Interests: Declarations. Conflict of Interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Keywords: Sleeve gastrectomy; Esophageal dysmotility; High-resolution manometry EN Sleeve gastrectomy Esophageal dysmotility High-resolution manometry 409 412 4 01/18/21 20210101 NES 210101 Dear Editor, Obesity is an ongoing global epidemic and a major predisposing factor to numerous chronic cardiovascular diseases, such as hyperlipidemia, hypertension, and diabetes. Men with severe obesity (BMI > 35) have been shown to have a 3-fold increase in risk of reflux symptoms compared to men of normal weight (BMI < 25). Instances in which a patient presents with complaints of reflux, regurgitation, and even vomiting may actually be secondary to dysphagia, with ejection of food retained in the esophagus. Abbreviations BMI Body mass index HRM High-resolution manometry GERD Gastroesophageal reflux disease LES Lower esophageal sphincter GI Gastrointestinal Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. [Extracted from the article]

Keywords: POSED; Revisional Surgery; Esophageal Dysmotility; Bariatric Surgery EN POSED Revisional Surgery Esophageal Dysmotility Bariatric Surgery 400 401 2 01/13/23 20230101 NES 230101 Key Points • Patients with stricture after Roux-en-Y gastric bypass [RYGB] may present with a presentation like post obesity surgery esophageal dysfunction [POSED]. Dilatation and Stenting We present a patient with a history of RYGB diagnosed with a paraesophageal hernia, stricture at the GJA with POSED not amenable to endoscopic stenting or dilation, and an incidental mesocolon hernia. [Extracted from the article]

Liraglutide is a glucagon-like peptide type 1 (GLP-1) analogue that is approved for long-term obesity management in North America. While bariatric surgery remains the gold standard for weight loss, an increasing number of patients are on liraglutide in the setting of ongoing workup for bariatric surgery. The presence of gastrointestinal symptoms prior to bariatric surgery may prompt testing for dysmotility, which affects surgical decision making. Here we report six cases where treatment with liraglutide was associated with reversible reduction in gastric and esophageal motility in screening for bariatric surgery. While liraglutide is known to delay gastric emptying, there are minimal reports of how this medication affects gastrointestinal investigations used in this context. The implications of these abnormal screening investigations on candidacy for bariatric surgery are discussed. [ABSTRACT FROM AUTHOR]

Introduction: The effect of the laparoscopic adjustable gastric band (LAGB) on esophageal acid exposure and reflux is poorly understood. Optimal technique and normative values for acid exposure have not been established in this group. Methods: High-resolution manometry (HRM) and 24-h ambulatory esophageal pH monitoring were performed in three groups: asymptomatic LAGB, symptomatic LAGB, and pre-operative reflux patients. This technique utilized intraluminal pressure signatures during HRM to guide accurate pH sensor placement. Results: The LAGB groups were well matched: age 48 vs 51 years ( p = 0.249), weight loss 27.3 vs 26.7 kg ( p = 0.911). The symptomatic group had a larger gastric pouch (5.2 vs 3.3 cm, p = 0.012), with higher esophageal acid exposure (10.8 vs 0.9%, p < 0.001). Two acidification patterns were observed: irritant and volume acidification, associated with substantial supine acidification. Symptomatic LAGB had altered esophageal motility, with poorer lower esophageal sphincter basal tone (8.0 vs 17.7 mmHg, p = 0.022) and impaired contractility of the lower esophageal segment (90 vs 40%, p = 0.009). Compared to pre-operative reflux patients, symptomatic LAGB patients demonstrated higher total and supine esophageal acid exposure (10.8 vs 7.0%, p = 0.010; 14.9 vs 5.1%, p < 0.001), less symptoms (2 vs 6, p = 0.001) and lower symptom index (0.7 vs 0.9, p = 0.010). Conclusions: Ambulatory pH monitoring is an effective technique if the pH sensor is positioned appropriately using HRM. The correctly positioned LAGB appears associated with low esophageal acidification. In contrast, patients with symptoms or pouch dilatation can have markedly elevated esophageal acidification, particularly when supine. This is a different pattern compared to pre-operative patients and importantly can be disproportionate to symptoms. [ABSTRACT FROM AUTHOR]

Background: The effect of the laparoscopic adjustable gastric band (LAGB) on the esophagus has been the subject of few studies despite recognition of its clinical importance. The aim of this study was to investigate the frequency and clinical effect of esophageal dysmotility and dilatation after LAGB. Methods: We undertook a retrospective analysis of 50 consecutive patients with no dysmotility on perioperative video contrast swallow who underwent primary LAGB operation. All patients had serial focused postoperative contrast studies for band adjustments at least 6 months post-LAGB. Clinical and radiological outcomes were assessed. Results: Median follow-up time was 18 months (range 7-39 months), and the median number of contrast swallows per patient was 5. The mean excess weight loss (EWL) overall was 47 % (standard deviation (SD) 22.3). Radiological abnormalities were recorded in 17 patients (34 %, 95 % confidence interval (CI) 21-49 %), of whom 15 had radiological dysmotility and 7 had esophageal dilatation (five patients had both dysmotility and dilatation). Of these 17 patients, six (35 %) developed significant symptoms of dysphagia, gastroesophageal reflux disease (GERD) or regurgitation requiring fluid removal. In comparison, 12 of 33 (36 %) patients without radiological abnormalities developed symptoms requiring fluid removal ( p = 1.00). Patients with radiological abnormalities were significantly older than those without these abnormalities. Symptoms were alleviated by removing fluid in most patients. Conclusions: The LAGB operation results in the development of radiological esophageal dysmotility in a significant proportion of patients. It is not clear if these changes are associated with an increased risk of significant symptoms. Fluid removal can reverse these abnormalities and their associated symptoms. [ABSTRACT FROM AUTHOR]