Introduction:
In Australia, over 15,000 bariatric procedures are performed annually. Following bariatric surgery, some patients may develop problematic dysphagia, reflux or regurgitation. A number of investigations are available to investigate these symptoms, including anatomical studies and oesophageal manometry. The utility of manometry in this setting is yet to be defined.
Methods:
A retrospective review was performed of post-bariatric patients with adverse symptoms undergoing high resolution manometry at a single bariatric practice between 2012 and 2016.
The data collected included: patient demographics, the indication for the investigation, peristaltic activity, lower oesophageal sphincter function, and presence of hiatus hernia. Most patients undergo anatomical studies including endoscopy hence the use of gastroscopy and the presence of significant findings was recorded.
Results:
71 patients were included in this study - 16 post-laparoscopic gastric band, 28 post-sleeve gastrectomy, and 27 post-bypass. The main symptoms being investigated were reflux, or regurgitation (n=38), and dysphagia (n=20).
76% of patients with reflux or regurgitation, and 65% with dysphagia had some form of manometric abnormality. Within the reflux group, there were 21 findings of abnormal oesophageal peristaltic function and 18 of lower oesophageal sphincter (LOS) dysfunction, while in the dysphagia group, there were 12 findings of oesophageal dysmotility and 5 of LOS dysfunction.
Gastroscopy was performed in 25 reflux patients, and 20 dysphagia patients, with an endoscopic abnormality seen in 48% and 40% respectively.
Conclusions:
In this cohort of symptomatic bariatric patients, the use of manometry to investigate post-operative symptoms identified abnormal findings in a large proportion of patients. The use of endoscopy yielded a lower rate of abnormal findings. These findings indicate that manometry may be a useful tool to detect functional disorders in symptomatic patients following bariatric surgery that may be missed by endoscopic examination.