Background: Gastric banding is being considered as an obesity treatment. However, there is poor understanding of the factors that lead to efficacy and may predispose to complications. The aim of this study was to determine the effect of gastric banding on esophageal function, gastro-esophageal reflux (GOR) and gastric emptying in morbidly obese adolescents.
Methods: 15 morbidly obese adolescents (6 male, 16.8±1.2yrs), undergoing laparoscopic gastric banding were recruited. All patients were investigated by high resolution impedance manometry, 24h pH/impedance and gastric emptying breath test. Investigations were performed at 3 study timepoints (baseline, pre surgery and 6-12 months post-surgery). At pre-surgery all patients had completed 4 weeks of a very low calorie diet (VLCD, Optifast®). In addition at all 3 study timepoints patients completed quality of life (QOL) questionnaires.
Results: After the 4wk VLCD patients achieved a significant weight loss compared to baseline (134.2 ± 6.4 vs 126.6 ± 6.9kg, p=0.004) and at post surgery follow up (105.0 ±7.2kg, p<0.001). Esophageal pressure flow index (PFI), a marker of bolus flow resistance, reduced from baseline to pre-surgery (31.96 ± 4.23 vs 16.63 ± 2.18, p=0.011) and then increased following surgery (16.63 ± 2.18 vs 30.77 ± 4.45, p=0.015). There were no differences in gastric emptying, total acid reflux index and number of non-acidic GOR episodes. Acidic GOR episodes at post surgery follow up were reduced (32.3 ± 6.5 vs 14.6 ± 3.8, p=0.007). For patients, only physical QOL scores improved both after the 4wk VLCD and at post surgery follow up.
0>Conclusions: Gastric banding appears to be an effective short term weight loss therapy. Reduced esophageal bolus flow resistance indicating improved esophageal function after the 4wk VLCD probably relates to reduced gastric pressure secondary to weight loss. Gastric banding placement had no effect on GOR and gastric emptying rate while improving QOL scores.