High-Amplitude Gastric Contractions following Laparoscopic Sleeve Gastrectomy

Figure 1

Examples of water swallows in post-LSG cases obtained with high-resolution impedance manometry at 30 mmHg isobaric contour. Impedance data are displayed by overlay pink colorization with the pink shading indicative of areas on the topography plots with bolus present. (a) An example of asymptomatic post-LSG peristaltic morphology. The 5 mL water swallows show intact peristalsis and complete bolus transit. A small amount of compartmentalized pressurization occurs at the hiatus hernia and propagates into the gastric sleeve (denoted by >). (b) Swallow morphology of the case study showing normal peristalsis until at the contractile deceleration point where compartmentalized pressurization generates high-amplitude, long-duration contraction below the diaphragm (denoted by ). This contraction propagates further down into the gastric sleeve. The increase in intragastric pressure correlates with transient LES relaxation which results in the retrograde movement of gastric bolus (arrows highlight incidences of this retrograde movement). The presence of bolus in the esophagus triggers an involuntary secondary peristalsis to clear the distal esophagus. This process is repeated in the second 5 mL water swallow. UES: upper esophageal sphincter; LES: lower esophageal sphincter.

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