Esophageal dilation after laparoscopic adjustable gastric banding: a more systematic approach is needed

Abstract

The occurrence of esophageal dilation after laparoscopic adjustable silicone gastric banding (LASGB) had not been yet investigated systematically. In this study, standardized barium swallow studies were used to assess 45 LASGB patients for the development of esophageal dilation after the operation and after a mean follow-up period of 39.3 months. The diameter of the esophagus postoperatively and during the follow-up period was calculated in millimeters using the known diameter of the gastric band. An increase in diameter exceeding 130% compared with the postoperative diameter was considered as dilation. Symptoms were assessed by a questionnaire. For 11 patients with dilation, the band was emptied and a barium swallow performed to assess whether the dilation was reversible. A significant increase in the esophageal diameter (median and interquartile range [IQR]) was found by comparing the early postoperative and follow-up data: median, 16.3 mm (IQR, 14-18.7 mm) versus median, 20.7 mm (IQR, 18.1-26.8 mm; p < 0.01). For 25 (55.6%) of the 45 patients, the dilation percentage exceeded 130%. For 7 of the 11 patients, the dilation after emptying of the band still exceeded 130%. The increase in esophageal diameter was significantly correlated with the duration of follow-up evaluation, regurgitation, heartburn at night, and slow esophageal clearance. Laparoscopic adjustable gastric banding causes esophageal dilation in about half of patients. This dilation is correlated with symptoms and is partly reversible after emptying of the band. The clinical relevance of the dilation is unclear.