Danielle T Friedman, MD1, Andrew J Duffy, MD2. 1Jacobi Medical Center, 2Yale University School of Medicine/Yale New Haven Hospital
INTRODUCTION: Esophageal motility disorders are increasingly recognized after laparoscopic adjustable gastric banding (LAGB) and may be underdiagnosed. Esophageal dilatation may serve as a precursor. This study characterizes the utility and outcomes of upper gastrointestinal series (UGIS) as a routine screening tool for esophageal dilatation and dysmotility in the ambulatory setting.
METHODS: We reviewed medical charts for all patients presenting for an outpatient surgical encounter related to LAGB between January 1, 2015 and December 31, 2017. Exclusion criteria included failure to undergo UGIS at least six months after initial band placement, or having undergone band placement in combination with or subsequent to an additional bariatric procedure. Descriptive statistics were used to characterize patient demographics, imaging findings and surgical outcomes. All imaging classifications were based on final radiologist report. Means were compared using a Student’s t-test.
RESULTS: A total of 322 records were reviewed with 39 patients excluded; 31 lacked an UGIS and 8 had concomitant gastric bypass surgery. 85% were female with an average age of 50 years. 66.8% identified as white or Caucasian with 24.7% black/African-American, 7.1% other, and 1.4% declining to answer. Upper GI series was performed due to the presence of symptoms (abdominal pain, reflux, dysphagia, regurgitation, or vomiting) in 187 patients (66.1%) and for routine screening, weight gain, or other non-symptom-associated reasons in 96 patients (33.9%). If presence or absence of symptoms at the time of UGIS could not be confirmed from the medical record, the patient was assigned as “symptomatic.” Of asymptomatic patients, 46 (47.9%) demonstrated esophageal dilatation or dysmotility on UGIS, similar to the rate of 52.6% in symptomatic patients. 96.8% of all patients reviewed went on to band removal, with 44.9% ultimately undergoing conversion to laparoscopic sleeve gastrectomy and 6.6% to laparoscopic roux-en-Y gastric bypass. Only one patient required laparoscopic Heller myotomy for persistent achalasia.
CONCLUSION(S): The observed esophageal dilatation and/or dysmotility on 50% of upper GI series, even among asymptomatic patients, is significantly higher than the incidence of pseudoachalasia reported in the literature. The use of routine surveillance UGIS in post-LAGB patients could provide an “early-warning” system and would likely be better tolerated than routine use of manometry. These radiologic findings may serve as a precursor to more severe motility disorders and should prompt a strong recommendation for band removal if identified. Our practice currently recommends yearly upper GI series for all patients after LAGB, even if asymptomatic.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95518
Program Number: S115
Presentation Session: Bariatric III – Optimizing Care and Pathways
Presentation Type: Podium
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