Pathophysiology of Laparoscopic Adjustable Gastric Bands: Analysis and Classification Using High-Resolution Video Manometry and a Stress Barium Protocol

Burton, Paul R.; Brown, Wendy A.; Laurie, Cheryl; Korin, Anna; Yap, Kenneth; Richards, Melissa N.; Owens, John C.; Crosthwaite, Gary; Hebbard, Geoff; O'Brien, Paul Edmond

doi:10.1007/s11695-009-9970-z

Cited by 41 publications

(24 citation statements)

References 23 publications

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“…Alternatively, when the lumen immediately above the LAGB dilates, or the contractility of the lower esophageal segment is impaired, patients develop adverse symptoms and are often unable to tolerate fluid within the LAGB. 22,23 This leads to a state of either unacceptable symptoms or inadequate weight loss.…”

Section: Transit Mediated By Esophageal Peristalsismentioning

confidence: 99%

The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction

Burton

Brown

2011

Int J Obes

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Laparoscopic adjustable gastric banding (LAGB) has rapidly emerged as a popular bariatric procedure because of its safety, efficacy, durability and adjustability. Despite widespread use, there is limited understanding of how it induces weight loss. Previously, it has been classified as a restrictive procedure, physically limiting the patient to a small meal that subsequently slowly empties into the distal stomach. However, the tiny pouch of stomach created above the LAGB appears to be unable to accommodate even the smallest of meals. Therefore, the key mechanism has been hypothesized to be the induction of satiety via, as yet, undefined pathways. The critical question remains: what are the key physiological changes that lead to satiety and weight loss? In successful LAGB patients, a consistent intraluminal pressure at the level of the LAGB of 26.9±19.8 mm Hg is observed. Studies using semi-solid swallows combined with intraluminal pressure recordings have demonstrated that semi-solid transit across the resistance of the LAGB is mediated by repeated esophageal peristaltic contractions (mean 4.5±2.9) that produce episodic flow, interspersed by reflux events. Failed transit results in obstruction and regurgitation, whereas dilatation of the supraband stomach induces severe and intolerable reflux. Overall gastric emptying does not appear to be significantly altered following LAGB. Focused investigations have shown that the supraband stomach is empty of an ingested meal 1-2 min after intake ceases. Considerable progress has been made in understanding the mechanical physiological effects of the LAGB on esophageal and proximal gastric function. These have been correlated with patient outcomes and sensations. On the basis of recent data, it appears that the LAGB activates the peripheral satiety mechanism without physically restricting the meal size. Therefore, it should not be classified as a restrictive procedure. The precise mechanism of weight loss with the LAGB remains to be delineated.

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Section: Transit Mediated By Esophageal Peristalsismentioning

confidence: 99%

The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction

Burton

Brown

2011

Int J Obes

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“…This is not considered a significant disturbance in esophageal function. When analyzed on the basis of total swallows, differences are even more difficult to appreciate, with symptomatic patients having only 10% less normal swallows than successful patients [10]. These statistical differences do not account for the completely different outcomes observed.…”

Section: Introductionmentioning

confidence: 99%

“…Normal contractility, with an attenuated lower esophageal sphincter that relaxes appropriately, is observed in successful patients [6]. Disappointingly, new standardized high-resolution manometry diagnostic criteria [9] have not proven clinically useful when applied to LAGB patients [10]. While symptomatic patients do have worse overall motility, almost all of this is accounted for by mild peristaltic impairment [10].…”

Section: Introductionmentioning

confidence: 99%

“…Disappointingly, new standardized high-resolution manometry diagnostic criteria [9] have not proven clinically useful when applied to LAGB patients [10]. While symptomatic patients do have worse overall motility, almost all of this is accounted for by mild peristaltic impairment [10]. This is not considered a significant disturbance in esophageal function.…”

Section: Introductionmentioning

confidence: 99%

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Criteria for Assessing Esophageal Motility in Laparoscopic Adjustable Gastric Band Patients: The Importance of the Lower Esophageal Contractile Segment

et al. 2009

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The LECS is a valuable measure of esophageal function in LAGB patients and complements conventional manometric criteria. Symptomatic patients have less normal swallows; however, these also frequently demonstrate a deficient LECS. Further information can be elucidated by performing swallows at differing LAGB volumes. High-resolution manometry, using these adapted criteria, is now a useful in the investigation in symptomatic LAGB patients.

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“…24 Burton studied the mechanism of action of the adjustable gastric band, which is considered the model of the restrictive principle. [25][26][27][28][29][30][31] He has accomplished detailed manometric and transit studies to reveal that the band is not restrictive in the sense commonly understood, but may rather induce diminished nutrient intake and weight loss for other reasons.…”

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confidence: 99%

Collaboration between basic science researchers and bariatric surgeons is a win/win proposition: view from the chair

2011

Int J Obes

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Bariatric surgery in humans offers a window of opportunity to further our understanding of obesity and associated diseases. In the morbidly obese subjects, physiological disturbances are amplified and their extreme manifestations are more easily measured. The significant and predictable effects of bariatric surgery present a striking contrast to preoperative morbid conditions. The bariatric procedure is a reproducible therapy occurring at a precise time point; this facilitates the recording of preoperative and postoperative parameters over a short period of time, with some assurance that the contrasted conditions will confirm or disprove hypotheses with manageable numbers of subjects, thus providing an economy of means and efforts in a shorter time frame.

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Pathophysiology of Laparoscopic Adjustable Gastric Bands: Analysis and Classification Using High-Resolution Video Manometry and a Stress Barium Protocol

Cited by 41 publications

References 23 publications

The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction

The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction

Criteria for Assessing Esophageal Motility in Laparoscopic Adjustable Gastric Band Patients: The Importance of the Lower Esophageal Contractile Segment

Collaboration between basic science researchers and bariatric surgeons is a win/win proposition: view from the chair

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