Background: Esophageal dilatation and dysmotility have been proposed as a potential complication of laparoscopic gastric banding (LAGB). The effect of the operation on the esophageal motility remains still uncertain.
HYPOTHESIS: We hypothesized that: a) esophageal dysmotility after LAGB does not occur; b) esophageal manometry (EM) and barium esophagogram (BE) are both required pre and postoperatively; and c) fluoroscopic guidance is mandatory during band adjustment.
Methods: Between 1/01 and 10/06, 829 patients underwent LAGB at our institution. Preoperatively EM and BE were performed routinely in every patient. EM was considered normal when, lower esophageal sphincter pressure (LESP) was 14-24 mmHg, peristalsis was found during 10 wet swallows and mean distal esophageal amplitude (DEA) was 100±40 mmHg. Non specific esophageal motility disorder (NSEMD) was defined by the presence of DEA <40 mmHg. Hypertensive peristalsis (HP) was considered when DEA was > 160 mmHg. Ineffective esophageal motility (IEM) when DEA < 30 mmHg. Forty patients underwent repeat esophageal manometry at 1 year. BE was consistently performed at the time of the band adjustment.
Results: 829 pts underwent EM before LAGB: LESP was 16±7 mmHg; 56% had normal peristalsis, 37% NSEMD, 4% HP and 3% IEM; DEA was 83±38 mmHg. Of the 40 pts who had EM at 1 year, 85% were women, age 41±42 years, preoperative BMI was 47±47 kg/m2. At 17±14 months the % excess body weight loss (% EBWL) was 40±39. Postoperatively, 4 pts (18%) showed esophageal dilatation on the esophagogram. The results of the manometry are shown in the table.
Conclusions: Our study suggested that, a) LAGB does not adversely affect esophageal motility; b) esophageal manometry is required to rule out esophageal motility disorders after LAGB; and c) in spite of using fluoroscopic guidance during band adjustments, esophageal dilatation still can occur.
Results

	Preoperative (40 pts)	Postoperative (40 pts)	p value
LESP (mmHg)	15±13	18±16	NS
Esophageal Body
Normal peristalsis	60%	70%	NS
NSEMD	26%	30%
HP	14%	-
IEM	-	-
DEA (mmHg)	88±71	65±64	NS