Abstract Background When patients present with disruptive symptoms after Metabolic Bariatric Surgery (MBS), delivery of effective therapy requires identification of the cause(s) of the symptoms. There are, however, no diagnostic schema radiologically, endoscopically, manometrically or using pH/Impedance studies that are validated for patients with abnormal or post-surgical anatomy. In addition to this, assumptions that bypass conversions are reliable for reflux control have proven incorrect when post-surgical patients are followed in the longer term. Despite these problems, combined modality investigations, when interpreted together can give correlative information that can be used to assist in decision making. Results In a series of 65 patients undergoing anatomic studies and physiology studies for foregut symptoms after MBS, only 20% of patients did not have identifiable anatomic or manometric abnormalities. In this cohort 50% of patients with reported normal anatomy had abnormal manometry whereas only 14% of patients with abnormal anatomy did not have abnormal manometry. This suggests that anatomic reporting can be insufficiently sensitive and raises the possibility of insufficient specificity/oversensitivity of oesophageal physiology studies. Accordingly, this presentation discusses enhanced anatomical reporting of the stomach and oesophagus, and how this can be related to symptoms, physiologic derangement and treatment outcomes.
Michael Talbot (Thu,) studied this question.