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ARTIGOS ORIGINAIS _____________Qualidade da informação da internet disponível para pacientes em páginas em português ___________________________________________________________645 Acesso a informações de saúde na internet: uma questão de saúde pública? ______650 Maus-tratos contra a criança e o adolescente no Estado de São Paulo, 2009_______659 Obesidade e hipertensão arterial em escolares de Santa Cruz do Sul – RS, Brasil ___666 Bone mineral density in postmenopausal women with and without breast cancer ___673 Prevalence and factors associated with thoracic alterations in infants born prematurely __________________________________________________679 Análise espacial de óbitos por acidentes de trânsito, antes e após a Lei Seca, nas microrregiões do estado de São Paulo ___________________________________685 Sobrevida e complicações em idosos com doenças neurológicas em nutrição enteral ______________________________________________________691 Infliximab reduces cardiac output in rheumatoid arthritis patients without heart failure ______________________________________________________698 Análise dos resultados maternos e fetais dos procedimentos invasivos genéticos fetais: um estudo exploratório em Hospital Universitário _______________703 Frequência dos tipos de cefaleia no centro de atendimento terciário do Hospital das Clínicas da Universidade Federal de Minas Gerais __________________709
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Revista da
ASSOCIAÇÃO MÉDICA BRASILEIRA
REV ASSOC MED BRAS. 2013;59(6):534-535
Image in Medicine
Megaesophagus after gastric band placement
for the treatment of morbid obesity
Megaesôfago pós-colocação de banda gástrica para tratamento
de obesidade mórbida
Elias Jirjoss Ilias*, Paulo Kassab, Carlos Alberto Malheiros, Wilson Freitas Jr, Fabio Thuler
Surgery Department, Faculty of Medical Sciences, Santa Casa of São Paulo, São Paulo, SP, Brazil
* Corresponding author.
E-mail: eliasilias@hotmail.com (E.J. Ilias).
Introduction
Gastric band is considered a less efficient treatment when compared to Roux-en-Y gastric bypass, although it is still used due to ease of implementation and low rate of perioperative mortality. At long term, the complications have been high, making this surgery almost prohibitive.1
This paper presents a case of megaesophagus grade IV after gastric band placement to treat morbid obesity.
Case presentation
Patient was 53-years, male, and, undergone a gastric band placement to treat morbid obesity for 9 years. One year ago he started presenting dysphagia, reflux, choking, coughing and wheezing.
Upper endoscopy was performed, showing erosive esophagitis, esophageal dilation and constriction in the gastric body with difficulty passage. Constriction was found at 3 cm from esophagogastric transition.
Contrastive X-ray of esophagus, stomach and duodenum showed dilated esophagus (grade IV) and dilation of stomach
to the proximal portion where is the already deflated gastric band, at 3 cm from the esophagogastric transition (Figs. 1 and 2).
Discussion
Stomach and esophagus dilation are rare, occasional descriptions of complications of gastric band. There are cases described of bronchoaspiration in late postoperative of gastric band placement. Bronchoaspiration is a serious complication that should be prevented by immediate deflation of the gastric band.2
A trial with 167 patients treated with gastric band showed disturbances of esophageal motility in 68% patients, and esophageal dilation in 25.5% patients. Six patients developed megaesophagus grade IV needing to remove the band.3
REV ASSOC MED BRAS. 2013;59(6):534-535
535
Some patients lacking proper instructions regarding food use the esophageal dilation as food reservoir, with consequent reflux and insufficient weight loss.5
Conclusion
What we have seen in daily medical care is that the gastric band has poor results in weight loss and high complication rates. These results have inhibited the indication of gastric bands worldwide, with failure rates reaching 60% in some studies. Several complications have been reported, the most common are insufficient weight loss, ischemic ulcers in the stomach in the band region, stomach dilation proximal to the band, and dysphagia. Now it is known that at long term megaesophagus with important dysphagia can occur, leading to the need for removal of the band and conversion to another type of surgery more efficiently and with fewer complications to treat morbid obesity.
R E F E R E N C E S
1. Nieuwenhove YV, Ceelen W, Stockman A, Vanommeslaeghe H, Snoeck E, Renterghem K, et al. Long-term results of a prospective study on laparoscopic adjustable gastric banding for morbid obesity. Obes Surg. 2011;21(4):582-7.
2. Hofer M, Stöllberger C, Finsterer J, Kriwanek S. Recurrent aspiration pneumonia after laparoscopic adjustable gastric banding. Obes Surg. 2007;17(4):565-7.
3. Naef M, Mouton WG, Naef U, van der Weg B, Maddern GJ, Wagner HE. Esophageal dysmotility disorders after laparoscopic gastric banding – an underestimated complication. Ann Surg. 2011;253(2):285-90.
4. Arias IE, Radulescu M, Stiegeler R, Singh JP, Martinez P, Ramirez A, et al. Diagnosis and treatment of megaesophagus after adjustable gastric banding for morbid obesity. Surg Obes Relat Dis. 2009;5(2):156-9.
5. Wiesner W, Hauser M, Schöb O, Weber M, Hauser RS. Pseudo-achalasia following laparoscopically placed adjustable gastric banding. Obes Surg. 2001;11(4):513-8.
Fig. 1 – Dolichos megaesophagus and dilatation of the stomach proximal to the band with esophagogastric stasis of the contrast.
