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Michel Suter, MD, PD; Gian Dorta, MD; Vittorio Giusti, MD, PD; Jean-Marie Calmes, MD

Arch Surg. 2005;140:639-643.

Background  Gastroesophageal reflux and progressive esophageal dilatation can develop after gastric banding (GB).

Hypothesis  Gastric banding may interfere with esophageal motility, enhance reflux, or promote esophageal dilatation.

Design  Before-after trial in patients undergoing GB.

Setting  University teaching hospital.

Patients and Methods  Between January 1999 and August 2002, 43 patients undergoing laparoscopic GB for morbid obesity underwent upper gastrointestinal endoscopy, 24-hour pH monitoring, and stationary esophageal manometry before GB and between 6 and 18 months postoperatively.

Main Outcome Measures  Reflux symptoms, endoscopic esophagitis, pressures measured at manometry, esophageal acid exposure.

Results  There was no difference in the prevalence of reflux symptoms or esophagitis before and after GB. The lower esophageal sphincter was unaffected by surgery, but contractions in the lower esophagus weakened after GB, in correlation with preoperative values. There was a trend toward more postoperative nonspecific motility disorders. Esophageal acid exposure tended to decrease after GB, with fewer reflux episodes. A few patients developed massive postoperative reflux. There was no clear correlation between preoperative testing and postoperative esophageal acid exposure, although patients with abnormal preoperative acid exposure tended to maintain high values after GB.

Conclusions  Postoperative esophageal dysmotility and gastroesophageal reflux are not uncommon after GB. Preoperative testing should be done routinely. Low amplitude of contraction in the lower esophagus and increased esophageal acid exposure should be regarded as contraindications to GB. Patients with such findings should be offered an alternative procedure, such as Roux-en-Y gastric bypass.

Author Affiliations: Department of Surgery (Drs Suter and Calmes), Division of Gastroenterology (Dr Dorta), and Department of Internal Medicine (Dr Giusti), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

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