CLINICAL RELEVANCE OF ESOPHAGEAL MOTILITY DISORDERS AFTER BARIATRIC SURGERY: A PROSPECTIVE STUDY BASED ON HIGH-RESOLUTION IMPEDANCE MANOMETRY.

Lucas Dos Santos Difante, Eduardo Neubarth Trindade, Antonio de Barros Lopes, Eduardo Ferreira Martins, Isadora Bosini Remus, Manoel Roberto Maciel Trindade
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Abstract

Background: There is recent evidence showing that obesity is associated with gastroesophageal reflux disease and esophageal dysmotility, although symptoms are not always present.

Aims: This is a prospective study based on high-resolution manometry findings in bariatric surgery candidates and their correlation with postoperative dysphagia.

Methods: Manometric evaluation was performed on candidates for bariatric surgery from 2022 to 2024. The examination was conducted according to the protocol of the fourth version of the Chicago Classification, including different positions and provocative maneuvers to confirm the diagnosis of dysmotility. Patients were followed for 90 days after surgery to verify the occurrence of dysphagia or difficulty adapting to the diet.

Results: High-resolution manometry was performed on 46 candidates for bariatric surgery with a mean body mass index of 46.5 kg/m2. Esophagogastric junction outflow obstruction was diagnosed in 16 (34.8%) patients, and ineffective esophageal motility was diagnosed in 8 (17.4%) patients. None of the subjects reported symptoms during the preoperative period. Out of the 46 individuals initially included, 44 underwent bariatric surgery, 23 (52.3%) underwent Roux-en-Y gastric bypass, and 21 (47.7%) underwent sleeve gastrectomy. One patient with esophagogastric junction outflow obstruction reported dysphagia after Roux-en-Y bypass, but symptoms spontaneously resolved during the 90-day follow-up period.

Conclusions: Although patients with severe obesity have a high prevalence of esophageal motility disorders, no clinical repercussions were observed after bariatric surgery during the study period.

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减肥手术后食管运动障碍的临床相关性:一项基于高分辨率阻抗测压的前瞻性研究。
背景:最近有证据表明,肥胖与胃食管反流病和食管运动障碍有关,尽管症状并不总是存在。目的:这是一项基于高分辨率测压结果的前瞻性研究,该结果与减肥手术患者术后吞咽困难的相关性有关。方法:对2022 ~ 2024年拟进行减肥手术的患者进行测压评估。检查按照第四版芝加哥分类的方案进行,包括不同的体位和刺激动作,以确认运动障碍的诊断。术后随访90天,观察患者是否出现吞咽困难或饮食适应困难。结果:对46例体重指数平均为46.5 kg/m2的减肥手术候选者进行了高分辨率测压。16例(34.8%)患者诊断为食管胃交界流出梗阻,8例(17.4%)患者诊断为食管运动不良。所有受试者术前均无症状报告。在最初纳入的46例患者中,44例接受了减肥手术,23例(52.3%)接受了Roux-en-Y胃旁路手术,21例(47.7%)接受了袖式胃切除术。1例食管胃交界流出梗阻患者在Roux-en-Y旁路手术后出现吞咽困难,但在90天的随访期间症状自行消退。结论:虽然重度肥胖患者有较高的食道运动障碍患病率,但在研究期间没有观察到减肥手术后的临床反应。
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