Evaluation of Esophageal Motility in Obese Patients before and after Bariatric Surgery: Role of Multichannel Intraluminal Impedance and High-resolution Manometry

Abstract

Abstract Background: A high prevalence of esophageal motor disorders has been reported in obese patients. Roux-en-Y gastric bypass (RYGB) can trigger symptoms of dysphagia by worsening preexisting esophageal motor disorders. Investigation of esophageal motility with multichannel intraluminal impedance (MII) and high-resolution manometry (HRM) is available. Objective: The aim is to compare the results of MII and HRM of nonobese patients with those of obese patients before and after RYGB to identify possible preoperative predictive factors of postoperative dysphagia. Materials and Methods: Twenty-eight obese patients were evaluated with a questionnaire of symptoms, endoscopy, HRM, and MII in different postures (supine and sitting) before and 6 months after laparoscopic RYGB. They were compared with eleven nonobese subjects. Chicago classification parameters were used to characterize esophageal motility disorders. Results: Obese patients evolved with more symptoms of dysphagia after surgery (7.10% preoperatively and 32.10% postoperatively). None had gastrojejunal anastomosis stenosis. After bariatric surgery, there was an increase in distal latency (HRM) and also a decrease in esophageal alimentary bolus progression (MII). Twenty-one percent of obese patients already had some dysmotility before the surgery and 92% of them evolved to dysphagia after the operation. Conclusions: Previous esophageal motility disorder is a good predictive factor of postoperative dysphagia. HRM and MII should be performed in some situations, such as bariatric surgery for older adults and before narrowing the gastrojejunal anastomosis as a treatment for weight recidivism.