FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2009848557> ?p ?o ?g. }

• W2009848557 endingPage "747" @default.
• W2009848557 startingPage "745" @default.
• W2009848557 abstract "The incidence of obesity in Western countries has dramatically increased along with its associated comorbidities (type 2 diabetes, hypertension, heart disease, cancer, etc) and diminished life expectancy.1 Attempts at controlling this with diet have proven relatively ineffective. Consequently, obese patients (especially with comorbidities) are increasingly referred for bariatric surgery. Within that domain, laparoscopic adjustable gastric banding (LAGB) has become more popular as it is associated with fewer short-term complications than gastric bypass procedures.2 However, as exemplified in the report by Khan et al, LAGB may induce esophageal motility disorders.3 In this issue of Journal of Clinical Gastroenterology, Khan et al reported 6 cases of esophageal dilatation and severe esophageal dysmotility after LAGB placement.3 All of the patients except one were symptomatic with dysphagia and/or regurgitation. Esophageal manometry performed with a conventional technique (pressure sensors spaced at 5 cm intervals) revealed absent peristalsis in all cases. Esophageal dilatation was present on barium swallow. These findings were consistent with pseudoachalasia. After liquid removal from the implant, symptoms improved in all but 1 patient. The band was then removed in that patient and symptoms resolved. Esophageal dilatation improved in all patients. Manometric findings were variable: 1 patient exhibited a return of normal peristalsis, 2 had partial return of peristalsis, and 2 had persistent absent peristalsis. These results emphasized the potential reversibility of pseudo-achalasia in patients with LAGB. The implications for the clinician are important; patients with dysphagia and/or regurgitation in the context of LAGB should be evaluated for pseudoachalasia. As pseudoachalasia in this setting may be reversible, band deflation or band removal should be advised in such patients. Esophageal manometry is the most sensitive procedure for the diagnosis of achalasia.4 The manometric criteria for achalasia are impaired esophago-gastric junction (EGJ) relaxation and absent peristalsis. High-resolution manometry with esophageal pressure topography (EPT) exhibits increased sensitivity for detecting achalasia because of better metrics for characterizing EGJ relaxation and distal esophageal contractility.5 EPT also allows for the differentiation of 3 clinically relevant achalasia subtypes.6 High-resolution manometry with EPT can also be useful in distinguishing some forms of secondary achalasia from primary idiopathic achalasia. For example, in the case of LAGB, the site of the banding may be identified as a high-pressure zone distal from the lower esophageal sphincter (LES), sometimes with the crural diaphragm superimposed (Fig. 1).7 The distinction between localizing the outflow obstruction at the LES or the Lapband is crucial in cases of suspected achalasia. Moreover, bolus clearance can also be inferred by the pattern of pressurization.8 A recent study using high-resolution manometry in 22 symptomatic Lapband patients revealed the presence of esophageal dysmotility in 90% and pressurization (compartmentalized or pan-esophageal) in 68%.9 The pressurization pattern in the gastric pouch seems to be quite characteristic of an obstruction induced by LAGB (Fig. 1) and is a useful sign for differentiating pseudo-achalasia induced by the band from primary idiopathic achalasia with obstruction at the level of the LES.FIGURE 1: EPT of a dysphagic patient with after LAGB exhibiting a pseudo-achalasia pattern. Although the patient exhibits EGJ outflow obstruction with bolus pressurization well above 30 mmHg, the site of the outflow obstruction is distal to the LES, instead localized to the site of the LAGB/crural diaphragm (CD) combination. Some peristalsis appears preserved, but this pattern of bolus pressurization is easily misinterpreted as a simultaneous contraction using conventional manometry techniques. Note also the occurrence of a transient LES relaxation with reflux followed by secondary peristalsis. EGJ indicates esophago-gastric junction; EPT, esophageal pressure topography; LAGB, laparoscopic adjustable gastric banding; LES, lower esophageal sphincter.Khan et al observed some degree of reversibility to pseudoachalasia after Lapband deflation or removal. However, absent peristalsis persisted in 2 patients. This may be attributable to irreversible neuromuscular damage to the esophagus or it may be a manifestation of persistent obstruction ultimately attributable to fibrosis at the previous location of the Lapband. Surgically, this is recognized as encapsulation of the implant and may perpetuate an obstruction even after deflation. Illustrative of this is Fig. 2 from a case report in which LAGB removal did not relieve dysphagia or normalize the EPT pattern. Only subsequent excision of the encapsulating fibrosis was associated with restoration of esophageal peristalsis in a patient presenting with pseudoachalasia from a Lapband.10 A corollary to the observation that esophageal peristalsis returns to normal after relieving EGJ obstruction is that the pathophysiology of idiopathic achalasia must also involve the distal esophagus proximal to the sphincter as recovery of peristalsis is not seen after treatment.FIGURE 2: Patient with pseudoachalasia after LAGB placement. Dysphagia and obstructive pattern persisted after deflation of the implant (left) and removal of the implant (center). Only after surgical dissection to remove the encapsulating fibrosis was the obstruction relieved and peristalsis restored (right). LAGB indicates laparoscopic adjustable gastric banding.In conclusion, the risk of pseudoachalasia must be included among potential risks when LAGB placement is considered and pseudoachalasia should be recognized as a potential complication in the evaluation of postprocedure dysphagia and/or regurgitation. Preliminary postoperative data in morbidly obese patients suggest that esophageal dysmotility was more frequent after LAGB than after Roux-en-Y bypass procedures.11 Hence, although the magnitude of the risk is unclear, LAGB clearly can cause a syndrome that strongly mimics achalasia and, even though the disorder is potentially reversible, early recognition is likely key to insuring this. High-resolution manometry is an elegant diagnostic tool in this regard." @default.
• W2009848557 created "2016-06-24" @default.
• W2009848557 creator A5029019814 @default.
• W2009848557 creator A5075811575 @default.
• W2009848557 date "2011-10-01" @default.
• W2009848557 modified "2023-10-14" @default.
• W2009848557 title "Pseudoachalasia and Laparoscopic Gastric Banding" @default.
• W2009848557 cites W2008017513 @default.
• W2009848557 cites W2009520555 @default.
• W2009848557 cites W2021946345 @default.
• W2009848557 cites W2024824910 @default.
• W2009848557 cites W2061011890 @default.
• W2009848557 cites W2085052168 @default.
• W2009848557 cites W2087008114 @default.
• W2009848557 cites W2102714836 @default.
• W2009848557 cites W2143075454 @default.
• W2009848557 cites W2151723426 @default.
• W2009848557 doi "https://doi.org/10.1097/mcg.0b013e318228c802" @default.
• W2009848557 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/3174396" @default.
• W2009848557 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/21918386" @default.
• W2009848557 hasPublicationYear "2011" @default.
• W2009848557 type Work @default.
• W2009848557 sameAs 2009848557 @default.
• W2009848557 citedByCount "13" @default.
• W2009848557 countsByYear W20098485572014 @default.
• W2009848557 countsByYear W20098485572017 @default.
• W2009848557 countsByYear W20098485572019 @default.
• W2009848557 countsByYear W20098485572020 @default.
• W2009848557 countsByYear W20098485572021 @default.
• W2009848557 countsByYear W20098485572022 @default.
• W2009848557 crossrefType "journal-article" @default.
• W2009848557 hasAuthorship W2009848557A5029019814 @default.
• W2009848557 hasAuthorship W2009848557A5075811575 @default.
• W2009848557 hasBestOaLocation W20098485571 @default.
• W2009848557 hasConcept C112497637 @default.
• W2009848557 hasConcept C126322002 @default.
• W2009848557 hasConcept C141071460 @default.
• W2009848557 hasConcept C151730666 @default.
• W2009848557 hasConcept C206813253 @default.
• W2009848557 hasConcept C2776109754 @default.
• W2009848557 hasConcept C2776928572 @default.
• W2009848557 hasConcept C2777014526 @default.
• W2009848557 hasConcept C2777819096 @default.
• W2009848557 hasConcept C2777938841 @default.
• W2009848557 hasConcept C2778510232 @default.
• W2009848557 hasConcept C2779134260 @default.
• W2009848557 hasConcept C2779343474 @default.
• W2009848557 hasConcept C2779958274 @default.
• W2009848557 hasConcept C2780168065 @default.
• W2009848557 hasConcept C2780596822 @default.
• W2009848557 hasConcept C2780942740 @default.
• W2009848557 hasConcept C2781168508 @default.
• W2009848557 hasConcept C3020583074 @default.
• W2009848557 hasConcept C43270747 @default.
• W2009848557 hasConcept C511355011 @default.
• W2009848557 hasConcept C544821477 @default.
• W2009848557 hasConcept C71924100 @default.
• W2009848557 hasConcept C86803240 @default.
• W2009848557 hasConcept C90924648 @default.
• W2009848557 hasConceptScore W2009848557C112497637 @default.
• W2009848557 hasConceptScore W2009848557C126322002 @default.
• W2009848557 hasConceptScore W2009848557C141071460 @default.
• W2009848557 hasConceptScore W2009848557C151730666 @default.
• W2009848557 hasConceptScore W2009848557C206813253 @default.
• W2009848557 hasConceptScore W2009848557C2776109754 @default.
• W2009848557 hasConceptScore W2009848557C2776928572 @default.
• W2009848557 hasConceptScore W2009848557C2777014526 @default.
• W2009848557 hasConceptScore W2009848557C2777819096 @default.
• W2009848557 hasConceptScore W2009848557C2777938841 @default.
• W2009848557 hasConceptScore W2009848557C2778510232 @default.
• W2009848557 hasConceptScore W2009848557C2779134260 @default.
• W2009848557 hasConceptScore W2009848557C2779343474 @default.
• W2009848557 hasConceptScore W2009848557C2779958274 @default.
• W2009848557 hasConceptScore W2009848557C2780168065 @default.
• W2009848557 hasConceptScore W2009848557C2780596822 @default.
• W2009848557 hasConceptScore W2009848557C2780942740 @default.
• W2009848557 hasConceptScore W2009848557C2781168508 @default.
• W2009848557 hasConceptScore W2009848557C3020583074 @default.
• W2009848557 hasConceptScore W2009848557C43270747 @default.
• W2009848557 hasConceptScore W2009848557C511355011 @default.
• W2009848557 hasConceptScore W2009848557C544821477 @default.
• W2009848557 hasConceptScore W2009848557C71924100 @default.
• W2009848557 hasConceptScore W2009848557C86803240 @default.
• W2009848557 hasConceptScore W2009848557C90924648 @default.
• W2009848557 hasIssue "9" @default.
• W2009848557 hasLocation W20098485571 @default.
• W2009848557 hasLocation W20098485572 @default.
• W2009848557 hasLocation W20098485573 @default.
• W2009848557 hasLocation W20098485574 @default.
• W2009848557 hasLocation W20098485575 @default.
• W2009848557 hasOpenAccess W2009848557 @default.
• W2009848557 hasPrimaryLocation W20098485571 @default.
• W2009848557 hasRelatedWork W2009848557 @default.
• W2009848557 hasRelatedWork W2247868822 @default.
• W2009848557 hasRelatedWork W2314949235 @default.
• W2009848557 hasRelatedWork W2357229550 @default.
• W2009848557 hasRelatedWork W2414106284 @default.
• W2009848557 hasRelatedWork W3000449811 @default.

• next