O'Rourke Robert W, Seltman Ann K, Chang Eugene Y, Reavis Kevin M, Diggs Brian S, Hunter John G, Jobe Blair A
Department of Surgery, Oregon Health and Science University, Portland, OR 97207, USA.
Ann Surg. 2006 Nov;244(5):723-33. doi: 10.1097/01.sla.0000218082.12999.9a.
This work establishes an animal model for nonadjustable gastric banding and characterizes the effect of gastric banding on esophageal physiology.
Obstruction at the esophagogastric junction (EGJ) results in esophageal dilation and aperistalsis. Although laparoscopic gastric banding as a primary treatment of morbid obesity has been widely accepted, the effects of this therapy on esophageal function remain unknown.
Twenty-five opossums were randomly divided into sham (n = 5), EGJ band (n = 5), and gastric band (n = 15) groups. Gastric and EGJ bands were surgically placed, and esophageal manometry was performed prebanding, at 2-week intervals during the banding period (up to 14 weeks), and 2 and 4 weeks after band removal.
Manometric measures were equivalent prior to banding in all groups. There were no changes in LES or esophageal pressures during the study period in the sham group. During banding, there was a 36% decrease in baseline mean resting lower esophageal sphincter pressure in the gastric band group (P = 0.003). Mean distal esophageal peristaltic pressure decreased from baseline by 36% in gastric band animals (P < 0.001). The incidence of esophageal motility disorder during the study period for sham, EGJ band, and gastric band groups, was 2.9%, 42.1%, and 31.3%, respectively (P = 0.001, P = 0.381, pairwise comparisons of gastric band vs. sham and gastric band versus EGJ groups, respectively). Immediately prior to band removal, the probability of an abnormal peristaltic sequence with each swallow was 1%, 38%, and 16% for sham, EGJ, and gastric band groups, respectively (P < 0.005, pairwise comparisons of band groups with sham).
Nonadjustable gastric banding results in impaired esophageal body motility, a reduction in esophageal peristaltic pressure, and a reduction in resting lower esophageal sphincter pressure. These findings suggest that gastric banding causes esophageal outlet obstruction and subsequent decompensation of peristaltic function as well as a compromise of the native antireflux mechanism.
本研究建立了不可调节胃束带术的动物模型，并描述了胃束带术对食管生理功能的影响。
食管胃交界（EGJ）处梗阻可导致食管扩张和蠕动消失。尽管腹腔镜胃束带术作为病态肥胖的主要治疗方法已被广泛接受，但该疗法对食管功能的影响仍不清楚。
25只负鼠随机分为假手术组（n = 5）、EGJ束带组（n = 5）和胃束带组（n = 15）。通过手术放置胃和EGJ束带，并在束带前、束带期间（最长14周）每隔2周以及束带移除后2周和4周进行食管测压。
所有组在束带前的测压指标相当。假手术组在研究期间LES或食管压力无变化。在束带期间，胃束带组的基线平均静息下食管括约肌压力下降了36%（P = 0.003）。胃束带动物的平均远端食管蠕动压力较基线下降了36%（P < 0.001）。假手术组、EGJ束带组和胃束带组在研究期间食管动力障碍的发生率分别为2.9%、42.1%和31.3%（P = 0.001，胃束带组与假手术组以及胃束带组与EGJ组的两两比较，分别为P = 0.381）。在束带移除前，假手术组、EGJ组和胃束带组每次吞咽出现异常蠕动序列的概率分别为1%、38%和16%（P < 0.005，束带组与假手术组的两两比较）。
不可调节胃束带术导致食管体部动力受损、食管蠕动压力降低以及静息下食管括约肌压力降低。这些发现表明胃束带术导致食管出口梗阻以及随后的蠕动功能失代偿，同时损害了天然抗反流机制。
