Department of Surgery, Gastrointestinal Section, Yale University, New Haven, CT, USA.
Department of Surgery, Jacobi Medical Center, 1400 Pelham Parkway South, Building 1, 2N25, Bronx, NY, 10461, USA.
Surg Endosc. 2020 May;34(5):2178-2183. doi: 10.1007/s00464-019-07005-4. Epub 2019 Jul 25.
Esophageal dilatation and dysmotility are known complications of the laparoscopic adjustable gastric band (LAGB), but their incidence varies widely in the literature. There are no formal recommendations guiding surveillance for these potentially underdiagnosed pathologies. This study demonstrates the utility and outcomes of a yearly upper gastrointestinal series screening protocol to detect and manage esophageal dysfunction after LAGB.
We reviewed charts for all patients presenting for an outpatient surgical encounter related to LAGB between January 1, 2015 and December 31, 2017. Exclusion criteria included failure to undergo UGIS 6 months or more after band placement, or having undergone band placement in combination with another bariatric procedure. Descriptive statistics were used to characterize demographics, imaging findings and surgical outcomes. All imaging classifications were based on final radiologist report. Means were compared using a Student's t test.
A total of 322 records were reviewed with 39 patients excluded; 31 without UGIS and 8 with concomitant gastric bypass. 85% were female with an average age of 50 years. 66.8% identified as white or Caucasian with 24.7% black/African-American. Greater than 75% of the cohort had at least 5-year follow-up interval. UGIS was performed for symptoms in 66.1% and for routine screening in 33.9%. Of asymptomatic patients, 47.9% demonstrated esophageal dilatation or dysmotility on UGIS, similar to 51.3% of symptomatic patients. 96.8% of all patients went on to band removal. Sixty-four patients had repeat UGIS an average of 8 months following band removal, of which 40.6% were persistently abnormal.
The incidence of esophageal pathology was significantly higher than most reported series, as was the number of patients with persistently abnormal UGIS despite band removal. The data supports our policy of yearly UGIS for all post-LAGB patients, with strong recommendation for band removal if esophageal dilatation or dysmotility is found.
食管扩张和运动障碍是腹腔镜可调胃带（LAGB）的已知并发症，但文献中其发病率差异很大。对于这些潜在未被诊断的病理学，目前没有正式的建议来指导监测。本研究展示了每年进行上消化道系列筛查方案的实用性和结果，以检测和管理 LAGB 后食管功能障碍。
我们回顾了 2015 年 1 月 1 日至 2017 年 12 月 31 日期间因 LAGB 而接受门诊手术的所有患者的图表。排除标准包括在带放置后 6 个月或更长时间未进行 UGIS，或在放置带的同时进行了另一种减肥手术。使用描述性统计来描述人口统计学、影像学发现和手术结果。所有影像学分类均基于最终放射科医生的报告。使用学生 t 检验比较平均值。
共审查了 322 份记录，其中 39 份被排除在外；31 份没有 UGIS，8 份有胃旁路术。85%为女性，平均年龄为 50 岁。66.8%为白种人或高加索人，24.7%为黑种人或非裔美国人。超过 75%的患者有至少 5 年的随访间隔。UGIS 是为症状进行的，占 66.1%，为常规筛查进行的，占 33.9%。在无症状患者中，47.9%的患者 UGIS 显示食管扩张或运动障碍，与 51.3%的有症状患者相似。所有患者中有 96.8%进行了带移除。64 名患者在带移除后平均 8 个月进行了重复 UGIS，其中 40.6%持续异常。
食管病变的发生率明显高于大多数报告的系列，尽管移除了带，但仍有许多患者 UGIS 持续异常。该数据支持我们对所有 LAGB 后患者进行每年 UGIS 的政策，如果发现食管扩张或运动障碍，强烈建议移除带。
