Is Preoperative Manometry in Restrictive Bariatric Procedures Necessary?

Abstract

Preoperative esophageal manometry is advised for restrictive procedures such as AGB and SG.

Upper gastrointestinal investigations before gastric banding

“…Suter et al [17] found that abnormal pH monitoring predicted overall long-term complications, especially food intolerance and pouch dilation and that a high pressure of the lower esophageal sphincter was related to long-term food intolerance. Consistent with this, Klaus and Weiss [18] stated recently that preoperative esophageal manometry is advised for restrictive procedures such as LAGB because functional disorders of the esophageal body and the lower esophageal sphincter can be identified before surgery. As a consequence, LAGB should not be considered a therapeutic option for patients with weak esophageal body motility because esophageal dilation, esophageal stasis, and consequent esophagitis could occur during long-term follow-up evaluation, and band deflation would be inevitable.…”

“…The current literature suggests an association between the function of the upper digestive tract and long-term complications after LAGB [17,18]. We analyzed the potential impact of preoperative upper gastrointestinal (GI) testing on outcome after LAGB.…”

“…They found, that abnormal pH monitoring predicts overall long-term complications, especially food intolerance and pouch dilation. According to a current recommendation, extended upper gastrointestinal (GI) testing including endoscopy, 24-h pH monitoring, and esophageal manometry may be a valuable tool for selecting patients to undergo gastric banding [18].…”

Esophageal dilation after gastric banding: to test or not to test before surgery?

“…Routine preoperative esophageal manometry has been advocated by some authors [8,9], in order to detect esophageal motility disorders that could influence the outcomes after bariatric surgery. However, this systematic preoperative esophageal testing should be recommended only if it could predict these complications and assist the choice of another type of bariatric surgery less prone to induce them.…”

“…Postoperative emesis was more frequent in patients with abnormal manometry findings, but was managed medically as effectively as in the group with normal manometry. Klaus and Weiss [8] advocated the use of preoperative manometry before gastric banding: they proposed that low amplitude of distal esophageal contractions and low LES pressure are contraindications for gastric banding, but their data are not definitely convincing, as they did not show that postoperative dysphagia occurred more frequently in patients with preoperative esophageal dyskinesia. Similarly, Merrouche et al [11] found 5 patients with postoperative esophageal ''dyskinesia'' among a cohort of 60 gastric banding, 2 out of 5 with ''pseudo-achalasia'' manometric findings: all these 5 patients had a normal esophageal manometry before surgery.…”