Abstract
A proportion of laparoscopic sleeve gastrectomy patients experience symptoms of regurgitation and epigastric pain postoperation. The appearance of gastric sleeve contractions has been documented but its implications have not been adequately investigated. This case describes a 61-year-old female following laparoscopic sleeve gastrectomy. The patient underwent high-resolution impedance esophageal manometry that identified compartmentalized pressurization leading to propagating contractions throughout the gastric sleeve. Combined treatment with calcium channel blockers and gastric sleeve dilation relieved all symptoms. This case highlights the application of high-resolution impedance esophageal manometry to assess motor function and bolus transit in patients following laparoscopic sleeve gastrectomy.
Highlights
Laparoscopic sleeve gastrectomy (LSG) is an increasingly utilized bariatric surgical procedure
Following LSG, chronic complications including gastroesophageal reflux disease, nausea, epigastric pain, and regurgitation during consumption of solids and liquids are reported in 29%-46% of patients [1, 2]
Causes of post-SG symptoms have been attributed to the following: increased intraluminal gastric sleeve pressure [3, 4], narrowing or stenosis of the gastric sleeve [5], abnormal lower esophageal sphincter (LES) pressure [6, 7], and hypertensive esophagus [8]. Another potential cause of symptoms is propagating contractions from the lower esophageal sphincter into the gastric sleeve. Aside from this feature being observed in post-LSG fluoroscopy swallow studies [9, 10], little is documented on the effects of abnormal sleeve contractions on symptoms and bolus transit
Summary
Laparoscopic sleeve gastrectomy (LSG) is an increasingly utilized bariatric surgical procedure. Following LSG, chronic complications including gastroesophageal reflux disease, nausea, epigastric pain, and regurgitation during consumption of solids and liquids are reported in 29%-46% of patients [1, 2]. These complications are incompletely understood and may be difficult to treat. In 11 of 20 test swallows, compartmentalized pressurization was generated below the lower esophageal sphincter (LES) and propagated into the gastric sleeve, where a high-amplitude contraction generated “inverted” pressurization (Figure 1(b)). Thirteen months following LSG and four months after the second dilation, the patient reported no further nausea, epigastric pain, or regurgitation symptoms. Her BMI was 31 kg/m2 which was maintained through a program of regular exercise and dietary modification
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