PMC6360550_01
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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fig1
In 11 of 20 test swallows, compartmentalized pressurization was generated below the lower esophageal sphincter (LES) and propagated into the gastric sleeve, where a high-amplitude contraction generated "inverted" pressurization (Figure 1(b)).
Examples of water swallows and subsequent gastric sleeve contractions obtained with high-resolution impedance manometry. The catheter was intubated 20 cm beyond the suggested position of 43 cm, to capture compartmentalized pressurization in the proximal gastric sleeve leading to propagating contractions in the distal gastric sleeve (denoted by *). UES: upper esophageal sphincter; LES: lower esophageal sphincter.
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fig2
In 4 of the 8 swallows, compartmentalized pressurization at the EGJ propagated into the gastric sleeve leading to high-amplitude contractions (Figure 2).