ArticleSurgical endoscopy2026
Special findings in high-resolution manometry prior to metabolic surgery: obesity as a risk factor for esophagogastric junction outflow obstruction or achalasia?
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe influence of obesity on the function of the upper gastrointestinal tract is still a matter of discussion. Clearly, there is a higher risk for hiatal hernia and gastroesophageal reflux disease (GERD) in obesity. However, the association between obesity and changes in the lower esophageal sphincter (LES) and esophageal motility disorders is insufficiently understood. The clinical impact of obesity on the gastroesophageal junction, like esophagogastric junction outflow obstruction (EGJOO), remains unclear.
methodsAll obese patients who underwent High-Resolution Manometry (HRM) before metabolic surgery between 2017 and 2021 were investigated. The findings in HRM were analyzed using the Chicago Classification version 3.0 and transferred to an Excel sheet. For the calculation of p-values, Fisher's exact test, chi-square test, or Student's t-test was applied.
resultsIn total, 188 patients were included: There were more female (f = 132) than male (m = 56) patients (70.2% vs. 29.8%), median age was 41.1 years, and median Body Mass Index (BMI) was 45.1 kg/m
conclusionEGJOO is markedly more prevalent on HRM in patients with obesity than in the general population, with male sex and very high BMI as significant risk factors, likely mediated by increased intra-abdominal pressure. Because most cases are asymptomatic, EGJOO should often be regarded as an incidental finding, and management should be guided by symptoms (e.g., chest pain and/or dysphagia). Given resource constraints, our preoperative HRM is now selective: It is routinely performed in sleeve gastrectomy candidates and in patients with dysphagia-type complaints. We therefore recommend extending CCv4.0-based manometry testing primarily in symptomatic patients prior to surgery, while asymptomatic patients can proceed to metabolic-bariatric surgery without evidence of increased perioperative risk.
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