The Effect of Laparoscopic Adjustable Gastric Bands on Esophageal Motility and the Gastroesophageal Junction: Analysis Using High-Resolution Video Manometry

Burton, Paul R.; Brown, Wendy A.; Laurie, Cheryl; Richards, Melissa N.; Afkari, Sohail; Yap, Kenneth; Korin, Anna; Hebbard, Geoffrey; O'Brien, Paul Edmond

doi:10.1007/s11695-009-9845-3

Cited by 91 publications

(92 citation statements)

References 21 publications

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“…Potential aetio logies include incompletely expressed or early achalasia, oesophageal wall stiffness from an infiltrative disease or cancer, vascular obstruction, sliding or para-oesophageal hiatal hernia, abdominal obesity or the effects of opiates 44 . Similar findings are found also in patients with dysphagia after restrictive, antireflux and bariatric procedures [45][46][47] . However, two series published in the past few years found that many patients with EGJOO were minimally symptomatic or asymptomatic, that in 20-40% of cases the 'disorder' resolved spontaneously, and that only 12-40% were treated (conservatively) as having achalasia 48,49 .…”

Section: Achalasia With Preserved Peristalsissupporting

confidence: 81%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

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High-resolution manometry (HRM), along with the analysis algorithms characterized in the Chicago Classification (CC) first proposed in 2008, have led to a major restructuring of the classification of oesophageal motility disorders. The inherently quantitative output of HRM devices fuelled enthusiastic expectation among motility experts that these advances would add a level of precision to the diagnosis of oesophageal motility disorders that was not previously possible. Nowhere was this advance more evident than in our concept of achalasia, now differentiated into subtypes as a direct result of HRM. Coincident with the assimilation of HRM into clinical practice was the development of a major therapeutic intervention for the management of oesophageal motility disorders, per-oral endoscopic myotomy (POEM). Not only does the POEM procedure provide a therapeutic option for myotomy with reduced morbidity relative to laparoscopic or open myotomy, but it also enables a calibrated intervention that is customized to patient-specific physiology. Together, these develop ments fostered an increasing emphasis on targeting therapy to specific aspects of oesophageal dysfunction, as measured by physiological testing, rather than discrete diagnoses. Again, nowhere is this evolution more evident than in our strategies for managing achalasia. This Consensus Statement examines the effect of HRM on our current understanding of oesophageal motility disorders with a focus on how this technology has affected the diagnosis, epidemiology and management of achalasia and achalasia-like syndromes. on behalf of the International Working Group for Disorders of Gastrointestinal Motility and FunctionAbstract | High-resolution manometry (HRM) and new analysis algorithms, summarized in the Chicago Classification, have led to a restructured classification of oesophageal motility disorders. This advance has led to increased detection of clinically relevant disorders, in particular achalasia. It has become apparent that the cardinal feature of achalasia -impaired lower oesophageal sphincter (LES) relaxation -can occur in several disease phenotypes: without peristalsis (type I), with pan-oesophageal pressurization (type II), with premature (spastic) distal oesophageal contractions (type III), or with preserved peristalsis (outlet obstruction). Furthermore, no manometric pattern is perfectly sensitive or specific for achalasia caused by a myenteric plexopathy, and there is no biomarker for this pathology. Consequently, physiological testing reveals other syndromes not meeting achalasia criteria that also benefit from therapies formerly reserved for achalasia. These findings have become particularly relevant with the development of a minimally invasive technique for performing a long oesophageal myotomy, the per-oral endoscopic myotomy (POEM). Optimal management is to render treatment in a phenotype-specific manner; that is, POEM calibrated to patient-specific physiology for spastic achalasia and the spastic disorders, and more conservative strategies...

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Section: Achalasia With Preserved Peristalsissupporting

confidence: 81%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

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“…This is based on successful patients consistently demonstrating an intraluminal pressure in the range of 25-30 mm Hg at the level of the LAGB. 7,19 This is despite variation in the device and the volume of saline within the LAGB, suggesting that the intraluminal pressure is important in mediating successful weight loss.…”

Section: Intraluminal Pressure Effectsmentioning

confidence: 99%

“…7,20 Repeated pressurizations progressively drive a swallowed bolus across the LAGB into the stomach. The time-limited-nature of peristaltic contractions causes episodes of flow to be interspersed by reflux events during which the bolus refluxes back into the esophagus-stimulating repeat peristalsis.…”

Section: Transit Mediated By Esophageal Peristalsismentioning

confidence: 99%

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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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“…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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The Effect of Laparoscopic Adjustable Gastric Bands on Esophageal Motility and the Gastroesophageal Junction: Analysis Using High-Resolution Video Manometry

Cited by 91 publications

References 21 publications

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

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

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

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