Preoperative Manometry for the Selection of Obese People Candidate to Sleeve Gastrectomy

Abstract

Background:Sleeve gastrectomy may alter esophageal motility and lower esophageal sphincter pressure. Aim:To detect manometric changings in the esophagus and lower esophageal sphincter before and after sleeve gastrectomy in order to select patients who could develop postoperative esophageal motilitity disorders and lower esophageal sphincter pressure modifications. Methods:Seventy-three patients were selected. All were submitted to manometry before the operation and one year after. The variables analyzed were: resting pressure of the lower esophageal sphincter, contraction wave amplitude, duration of contraction waves, and esophageal peristalsis. Data were compared before and after surgery and to the healthy and non-obese control group. Exclusion criteria were: previous gastric surgery, reflux symptoms or endoscopic findings of reflux or hiatal hernia, diabetes and use of medications that could affect esophageal or lower esophageal sphincter motility. Results:49% of the patients presented preoperative manometric alterations: lower esophageal sphincter hypertonia in 47%, lower esophageal sphincter hypotonia in 22% and increase in contraction wave amplitude in 31%. One year after surgery, manometry was altered in 85% of patients: lower esophageal sphincter hypertonia in 11%, lower esophageal sphincter hypotonia in 52%, increase in contraction wave amplitude in 27% and 10% with alteration in esophageal peristalsis. Comparing the results between the preoperative and postoperative periods, was found statistical significance for the variables of the lower esophageal sphincter, amplitude of contraction waves and peristalsis. Conclusion:Manometry in the preoperative period of sleeve gastrectomy is not an exam to select candidates to this technique.

Manometric and pH-monitoring changes after laparoscopic sleeve gastrectomy: a systematic review

“…Thirty-seven articles were fully analyzed, and 21 further articles were excluded. Finally, 16 articles published between February 2013 and September 2019 were included [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33], as shown in the PRISMA flow diagram (Fig. 1) [14].…”

Esophageal Pathophysiologic Changes and Adenocarcinoma After Bariatric Surgery: A Systematic Review and Meta-Analysis

“…A total of 194 articles were excluded at this stage because they clearly did not fulfill the eligibility criteria, leaving 51 articles for full-text review. Finally, 27 studies (15 studies for SG ( 23 – 37 ), 10 studies for RYGB ( 38 – 47 ), and 2 studies for both surgeries ( 13 , 48 )) were eligible for inclusion in the systematic review and meta-analysis. The flow diagram of the study selection process is shown in Supplementary Item 2, Supplemental Digital Content 4, http://links.lww.com/CTG/A344 .…”

“…A total of 14 studies ( 13 , 23 – 27 , 29 – 33 , 36 , 37 , 48 ) (492 patients) and 11 studies ( 13 , 38 – 40 , 42 – 48 ) (417 patients) provided information on esophageal manometric changes after SG and RYGB, respectively. LES resting pressure was significantly decreased after SG (MD = −3.55 mm Hg; 95% CI −6.35 to −0.75; I 2 = 93%) but did not change after RYGB (MD = −0.15 mm Hg; 95% CI −0.86 to 0.55; I 2 = 51%).…”

“…The risk of IEM was significantly increased after both SG (RR = 2.82; 95% CI 1.34 to 5.98; I 2 = 0%) and RYGB (RR = 2.41; 95% CI 1.38 to 4.20; I 2 = 12%). All studies ( 29 , 37 , 38 , 42 , 43 ) used conventional method ( 49 ) to identify IEM except for 1 study ( 26 ) that used high-resolution manometry ( 50 ). The overall study outcomes of esophageal manometry are summarized in Table 3 , and the forest plots are outlined in Figures 1 and 2 .…”

Consecuencias fisiopatológicas y anatómicas posgastrectomía vertical tubular como posibles causas de enfermedad por reflujo gastroesofágico

“…Rebecchi et al 17 , no encontraron cambios en EEI y Del Genio et al 8 , con la manometría de alta resolución mostró que la función del EEI no sufría cambios, pero mostró peristalsis ineficaz y mal vaciamiento esofágico, pero sorprendentemente, estos mismos autores informaron incompetencia cardial o hernia hiatal asociada con la presencia de síntomas de reflujo con índice de síntomas aumentado, esofagitis endoscópica y ERGE di novo en el 5,4% de los pacientes. Por el contrario, otros autores 14,[18][19][20][21][22] , han demostrado un efecto nocivo sobre la presión del EEI, lo que indica una disminución de la presión del LES. Burgerhart 14 observó una disminución en la presión de reposo LES de 18,3 ± 9,2 a 11,0 ± 7,0 mmHg (p = 0,02) medida por manometría de alta resolución.…”