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Surgical Endoscopy

, Volume 31, Issue 2, pp 552–560 | Cite as

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 TutuianEmail author
Article

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.

Keywords

Bariatric surgery Impedance–manometry Endoscopy Obesity 

Abbreviations

BMI

Body mass index

BTT

Bolus transit time

DEA

Distal esophageal amplitude

EFT

Esophageal function testing

GERD

Gastroesophageal reflux disease

GI

Gastrointestinal

HPZ

High-pressure zone

LA

Los Angeles classification

LASGB

Laparoscopic adjustable silicone gastric banding

LES

Lower esophageal sphincter

LRYGBP

Laparoscopic Roux-en-Y gastric bypass

LVBG

Laparoscopic vertical banded gastroplasty

MII-EM

Combined impedance–manometry

PPIs

Proton pump inhibitors

Notes

Acknowledgments

We like to specifically acknowledge the hard work of our study nurse Patrizia Künzler with regard to patient and data management.

Funding

This study was funded by the Research Council of the University of Zurich and registered at ClinicalTrials.gov (NCT00680030).

Author’s contribution

Jan Borovicka and Radu Tutuian equally contributed to the study design, planned the study protocol. Both of them also performed data analysis and wrote the manuscript. Radu Tutuian obtained funding from the study from the Research Foundation of the University Hospital of Zurich/University of Zurich. Claudia Krieger-Gruebel, Boudewijn van der Weg, Michael Christian Sulz, and Philipp Bisang performed the procedures and analyzed the data. Martin Thurnheer performed all gastric bypass surgeries. Bernd Schultes and Jean-Pierre Gutzwiler performed data analysis and approved the final draft. Daniel Pohl wrote the study protocol. Michael Fried and Christa Meyenberger critically reviewed the analysis and approved the final draft. All authors have read and approved the final version of the manuscript.

Compliance with ethical standards

Disclosures

Radu Tutuian contributes to educational programs of Sandhill Scientific Inc. and Medical Measurements Systems (MMS) International. Travel support and speaker honoraria were received from Allmiral, AbbVie, Abbott, UCB in the past 2 years. Jan Borovicka, Claudia Krieger-Gruebel, Boudewijn van der Weg, Michael Christian Sulz, Philipp Bisang, Martin Thurnheer, Bernd Schultes, Jean-Pierre Gutzwiler, Daniel Pohl, Michael Fried, and Christa Meyenberger have no conflicts of interests that are relevant to the manuscript.

Supplementary material

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Supplementary material 1 (DOCX 10 kb)
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Supplementary material 2 (TIFF 50 kb)
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Supplementary material 3 (TIFF 47 kb)

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Jan Borovicka
    • 1
  • Claudia Krieger-Grübel
    • 1
  • Boudewijn van der Weg
    • 1
  • Martin Thurnheer
    • 2
  • Bernd Schultes
    • 2
  • Michael Christian Sulz
    • 1
  • Jean-Pierre Gutzwiler
    • 3
  • Philipp Bisang
    • 2
  • Daniel Pohl
    • 4
  • Michael Fried
    • 4
  • Christa Meyenberger
    • 1
  • Radu Tutuian
    • 4
    • 5
    Email author
  1. 1.Division of GastroenterologyKantonsspital St. GallenSt. GallenSwitzerland
  2. 2.Hirslanden ClinicSt. GallenSwitzerland
  3. 3.Private Gastroenterology PracticeThalwilSwitzerland
  4. 4.Division of GastroenterologyUniversity Hospital ZurichZurichSwitzerland
  5. 5.Division of Gastroenterology, University Clinics for Visceral Surgery and MedicineBern University HospitalBernSwitzerland

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