Department of Gastroenterology, Cooper University Hospital, Camden, New Jersey.
Cooper Medical School of Rowan University, Camden, New Jersey.
Surg Obes Relat Dis. 2022 Jan;18(1):85-94. doi: 10.1016/j.soard.2021.10.003. Epub 2021 Oct 7.
The increasing incidence of obesity has led to a rise in bariatric surgeries. Obesity can be associated with various gastrointestinal symptoms as well as abnormal findings on high-resolution esophageal manometry (HRM). Bariatric procedures have variable effects on esophageal function and may contribute to postoperative symptoms. Preoperative HRM is not performed routinely on patients undergoing bariatric surgery but may identify patients likely to experience postoperative esophageal symptoms via delineation of structural or functional abnormalities.
To evaluate whether prebariatric surgery HRM could predict persistent or de novo postoperative esophageal symptoms.
Academic tertiary care hospital, United States.
Retrospective data were collected for 20 patients undergoing HRM and 100 controls 18 years and older from May 2012 to May 2015. Propensity score matching was performed to adjust for baseline differences between the 2 groups. Preoperative and postoperative esophageal symptoms (reflux, dysphagia, nausea/vomiting, bloating, fullness, early satiety, pain, and intolerance) were compared between HRM and control patients, and associations among HRM findings, Chicago Classification, and symptoms were analyzed. All included patients had follow-up beyond 3 months postoperatively. Data were analyzed with 2-tailed Fisher's exact test, Wilcoxon rank-sum test, and odds ratio.
Compared to controls, patients undergoing preoperative HRM had a higher rate of postoperative chronic intolerance (25% versus 8%, P = .041). This difference was not observed in propensity score matching analysis. Identification of elevated integrated relaxation pressure and esophagogastric junction outflow obstruction predicted chronic intolerance (odds ratio = 21.0; 95% confidence interval: 1.40-314; P = .027 for each).
Preoperative HRM abnormalities were associated with postoperative symptoms in patients undergoing bariatric surgery. HRM can identify patients who are more likely to experience postoperative esophageal symptoms and may aid in discussion of suitability for surgery and selection of bariatric intervention.
肥胖症发病率的上升导致了减重手术的增加。肥胖症可能与各种胃肠道症状以及高分辨率食管测压（HRM）的异常发现有关。减重手术对食管功能有不同的影响，并可能导致术后症状。接受减重手术的患者通常不会进行术前 HRM，但可以通过描绘结构或功能异常来识别可能经历术后食管症状的患者。
评估减重术前 HRM 是否可以预测持续性或新发的术后食管症状。
美国一家学术性三级护理医院。
回顾性收集了 2012 年 5 月至 2015 年 5 月期间接受 HRM 检查的 20 例患者和 100 例年龄在 18 岁及以上的对照患者的数据。采用倾向评分匹配来调整两组间的基线差异。比较 HRM 组和对照组患者术前和术后的食管症状（反流、吞咽困难、恶心/呕吐、腹胀、饱胀、早饱、疼痛和不耐受），并分析 HRM 结果、芝加哥分类和症状之间的关系。所有纳入的患者术后随访时间均超过 3 个月。采用双侧 Fisher 精确检验、Wilcoxon 秩和检验和比值比进行数据分析。
与对照组相比，接受术前 HRM 的患者术后慢性不耐受的发生率更高（25%对 8%，P =.041）。在倾向评分匹配分析中未观察到这种差异。发现食管高压区松弛压力升高和食管胃连接部输出梗阻预测慢性不耐受（比值比=21.0；95%置信区间：1.40-314；P =.027 各）。
减重手术患者术前 HRM 异常与术后症状有关。HRM 可以识别出更有可能出现术后食管症状的患者，并有助于讨论手术的适宜性和选择减重干预措施。
