病态肥胖、胃束带术和胃旁路手术对食管症状、黏膜及功能的影响。

Effect of morbid obesity, gastric banding and gastric bypass on esophageal symptoms, mucosa and function.

作者信息

Borovicka Jan, Krieger-Grübel Claudia, van der Weg Boudewijn, Thurnheer Martin, Schultes Bernd, Sulz Michael Christian, Gutzwiler Jean-Pierre, Bisang Philipp, Pohl Daniel, Fried Michael, Meyenberger Christa, Tutuian Radu

机构信息

Division of Gastroenterology, Kantonsspital St. Gallen, 9001, St. Gallen, Switzerland.

Hirslanden Clinic, 9016, St. Gallen, Switzerland.

出版信息

Surg Endosc. 2017 Feb;31(2):552-560. doi: 10.1007/s00464-016-4996-5. Epub 2016 Jun 10.

DOI:10.1007/s00464-016-4996-5

PMID:27287911

Abstract

BACKGROUND

Obesity and gastroesophageal reflux disease (GERD) are commonly associated diseases. Bariatric surgery has been shown to have various impacts on esophageal function and GERD. Our aim was to evaluate changes in symptoms, endoscopic findings, bolus passage and esophageal function in patients after primary gastric bypass surgery as compared to patients converted from gastric banding to gastric bypass.

METHODS

Obese patients scheduled for laparoscopic Roux-en-Y gastric bypass (naïve-to-bypass) and patients who previously underwent gastric banding and were considered for conversion from gastric banding to gastric bypass (band-to-bypass) were included. Patients rated esophageal and epigastric symptoms (100 point VAS) and underwent upper endoscopy, impedance-manometry, and modified "timed barium swallow" before/after surgery.

RESULTS

Data from 66 naïve-to-bypass patients (51/66, 77 % females, mean age 41.2 ± 11.1 years) and 68 band-to-bypass patients (53/68, 78 % females, mean age 43.8 ± 10.0 years) were available for analysis. Esophageal symptoms, esophagitis, esophageal motility abnormalities and impaired esophageal bolus transit were more common in patients that underwent gastric banding compared to those that underwent gastric bypass. The majority of symptoms, lesions and abnormalities induced by gastric banding were decreased by conversion to gastric bypass. Esophagitis was present in 28/68 (41 %) and 13/47 (28 %) patients in the band-to-bypass group, pre- versus postoperatively, respectively, (p < 0.05). The percentage of swallows with normal bolus transit increased following transformation from gastric band to gastric bypass (57.9 ± 4.1 and 83.6 ± 3.4 %, respectively, p < 0.01).

CONCLUSIONS

From an esophageal perspective, gastric bypass surgery induces less motility disorders and esophageal symptoms and should be therefore favored over gastric banding in difficult to treat obese patients at risk of repeated bariatric surgery.

摘要

背景

肥胖症与胃食管反流病（GERD）是常见的相关疾病。减肥手术已被证明对食管功能和GERD有多种影响。我们的目的是评估初次胃旁路手术后患者与从胃束带术转换为胃旁路手术的患者在症状、内镜检查结果、食团通过情况和食管功能方面的变化。

方法

纳入计划进行腹腔镜Roux-en-Y胃旁路手术的肥胖患者（初次接受胃旁路手术）以及先前接受过胃束带术且考虑从胃束带术转换为胃旁路手术的患者（从胃束带术转换为胃旁路手术）。患者对食管和上腹部症状进行评分（100分视觉模拟量表），并在手术前后接受上消化道内镜检查、阻抗测压和改良的“定时吞钡试验”。

结果

66例初次接受胃旁路手术的患者（51/66，77%为女性，平均年龄41.2±11.1岁）和68例从胃束带术转换为胃旁路手术的患者（53/68，78%为女性，平均年龄43.8±10.0岁）的数据可供分析。与接受胃旁路手术的患者相比，接受胃束带术的患者食管症状、食管炎、食管动力异常和食管食团通过受损更为常见。通过转换为胃旁路手术，胃束带术引起的大多数症状、病变和异常情况有所减少。在从胃束带术转换为胃旁路手术的患者组中，术前和术后分别有28/68（41%）和13/47（28%）的患者存在食管炎（p<0.05）。从胃束带术转换为胃旁路手术后，食团正常通过的吞咽百分比增加（分别为57.9±4.1%和83.6±3.4%，p<0.01）。