Abstracts
2002 Digestive Disease Week

# 104773 Abstract ID: 104773 Prospective Surveillance of Gastro-Esophageal Reflux in Patients with Morbid Obesity after Laparoscopic Gastric Banding
Peter H Collet, Christian Gutschow, Paul M Schneider, Elfriede Bollschweiler, Arnulf H Hoelscher, 50931 Cologne, Germany

Objective: To reduce the weight in cases of morbid obesity, adjustable silicone gastric bands were used for more than ten years. Since 1993, this operation is also performed as laparoscopic gastric banding. In order to determine the potential influence of this operation on gastro-esophageal reflux, a prospective observation study was initiated. Method: From September 1997 to September 2001 30 pts. with morbid obesity, median Body Mass Index (BMI) 50 kg/m2 (39; 59,9), have been treated with the Swedish Adjustable Gastric Band (SAGB) by one surgeon (PMS) in a retrocardial technique creating a small pouch of 20ml. 16 pts. answered a standardized questionnaire and underwent an endoscopy of the upper GI tract, an esophageal manometry and a 24 hour pH monitoring before and after surgery (study group). Median follow-up was 24 (7 to 40) months. Results: Preoperatively, three pts. (18.7%) suffered from heartburn. Two of these pts. (66.7%) also had pathological 24-hour pH monitorings. There was no evidence of reflux in any of these pts. after surgery. Six pts. (37.5%) complained for the first time about reflux six months after the intervention and six pts. (37.5%) had a pathological 24 hour pH monitoring, correlating to a decrease of the peristaltic amplitudes in esophageal manometry. In one case esophagitis was present at endoscopy. Pts. with no evidence of gastro-esophageal reflux before surgery had significantly (p<0,05) increased levels of the total pH time < 4 in the esophageal probe. Conclusion: Although statistically not significant, it seems that there is an augmentation of gastroesophageal reflux after this operation. The pathomechanism could be based on a reduced clearance function of the esophagus, due to a decreased propulsivity. On the other hand, pts. with preexisting symptoms of gastroesophageal reflux are free of symptoms after surgery. A different pattern of reflux behavior was seen in pts. with reflux prior to surgery compared to those without.