Improvement of esophageal dysmotility after conversion from gastric banding to gastric bypass.

BACKGROUND

Patients undergoing adjustable gastric banding can develop clinically apparent alterations in esophageal motility. There is little data on how such patients do after band removal and revision to other bariatric operations. One article in the literature describes long term manometric evidence of dysmotility in a band patient converted to gastric bypass.

METHODS

132 patients undergoing placement of an adjustable gastric band by a single surgeon in a university hospital setting were followed over a two year period. 15 (11%) developed unrelenting dysphagia, reflux and regurgitation despite conservative management including complete deflation, and were revised to gastric bypass. Pre-revision contrast studies demonstrated esophageal dysmotility in all patients. The first seven were converted in a staged fashion, with a period of six to eight weeks between band removal and gastric bypass. During this time, motility was again studied to confirm a return to normal. The last eight were converted at the time of band removal and motility was restudied after gastric bypass.

RESULTS

Esophageal motility normalized radiologically after band removal and remained normal after conversion to bypass in all patients. Symptoms of dysphagia similarly resolved. The revisional complication rate was acceptable.

CONCLUSION

The presence of a gastric band may be sufficient in some patients to bring about esophageal dysmotility. However, many will bring this about through forced eating against the band. When the band is poorly tolerated and further weight loss is required, such patients can safely convert to gastric bypass and can expect a return to normal motility.