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Esophageal motility after laparoscopic sleeve gastrectomy

Authors Sioka E, Tzovaras G, Tsiopoulos F, Papamargaritis D, Potamianos S, Chatzitheofilou C, Zacharoulis D

Received 24 November 2016

Accepted for publication 27 March 2017

Published 20 July 2017 Volume 2017:10 Pages 187—194

DOI https://doi.org/10.2147/CEG.S128631

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 2

Editor who approved publication: Professor Andreas M Kaiser


Eleni Sioka,1 George Tzovaras,1 Fotios Tsiopoulos,2 Dimitris Papamargaritis,1 Spyros Potamianos,2 Constantine Chatzitheofilou,1 Dimitris Zacharoulis1

1Department of Surgery, 2Department of Gastroenterology, University Hospital of Larissa, University of Thessaly, Larissa, Greece

Background: Laparoscopic sleeve gastrectomy (LSG) modifies the upper gastrointestinal tract motility. Controversial data currently exist. The aim of the study was to evaluate esophageal motility before and after LSG.
Patients and methods: Morbid obese patients scheduled for LSG underwent reflux symptoms evaluation and manometry preoperatively and postoperatively. The preoperative and postoperative results were compared and analyzed.
Results: Eighteen patients were enrolled. Heartburn and regurgitation improved in 38.9% and 11.1% of the patients, but deteriorated in 11.1% and 27.8% of the patients, respectively. Lower esophageal sphincter (LES) total length decreased postoperatively (p=0.002). Resting and residual pressures tended to decrease postoperatively (mean difference [95% confidence interval]: −4 [−8.3/0.2] mmHg, p=0.060; −1.4 [−3/0.1] mmHg, p=0.071, respectively). Amplitude pressure decreased from 95.7±37.3 to 69.8±26.3 mmHg at the upper border of LES (p=0.014), and tended to decrease at the distal esophagus from 128.5±30.1 to 112.1±35.4 mmHg (p=0.06) and mid-esophagus from 72.7±34.5 to 49.4±16.7 mmHg (p=0.006). Peristaltic normal swallow percentage increased from 47.2±36.8 to 82.8±28% (p=0.003). Postoperative regurgitation was strongly negatively correlated with LES total length (Spearman’s r=−0.670). When groups were compared according to heartburn status, statistical significance was observed between the groups of improvement and deterioration regarding postoperative residual pressure and postoperative relaxation (p<0.002, p<0.002, respectively). With regard to regurgitation status, there was statistically significant difference between groups regarding preoperative amplitude pressure at the upper border of LES (p<0.056).
Conclusion: Patients developed decreased LES length and weakened LES pressure after LSG. Esophageal body peristalsis was also affected in terms of decreased amplitude pressure, especially at the upper border of LES. Nevertheless, body peristalsis was normalized postoperatively. LSG might not deteriorate heartburn. Regurgitation might increase following LSG due to shortening of LES length, particularly in patients with range of preoperative amplitude pressure at the upper border of LES of 38.9–92.6 mmHg.

Keywords: laparoscopic sleeve gastrectomy, motility, esophagus, manometry, gastro esophageal reflux, obesity surgery

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