60 (30 patients with the section at 3 cm and 30 patients with that at 8 cm from the pylorus
Gastric emptying by scintigraphy (T1/2 min), gastric volume by CT scan (cc) at 6 and 12 months
38F/3 cm/8 cm
Gastric emptying increases the speed significantly in both groups but is greater in the 3 cm group (). When dividing groups into type 2 diabetic patients and nondiabetic patients, the speed in nondiabetic patients is significantly higher for the 3 cm group. The residual volume increases significantly in both groups, and there are no differences between them. Gastric emptying is faster in patients with antrum resection. The distance does not influence the gastric emptying of diabetic patients.
8 (1 patient with chronic refux, nausea, and dysmotility)
Laparoscopic high-resolution (HR) electrical mapping before and after LSG
NR
The baseline activity showed exclusively normal propagation. Acutely after LSG, all patients developed either a distal unifocal ectopic pacemaker with retrograde propagation (50%) or bioelectrical quiescence (50%). The propagation velocity was abnormally rapid after LSG (12.5 ± 0.8 versus baseline 3.8 ± 0.8 mm s−1; ), whereas the frequency and amplitude were unchanged (2.7 ± 0.3 versus 2.8 ± 0.3 cpm, ; 1.7 ± 0.2 versus 1.6 ± 0.6 mV, ). In the patient with chronic dysmotility after LSG, mapping also revealed a stable antral ectopic pacemaker with retrograde rapid propagation (12.6 ± 4.8 mm s−1). The resection of the gastric pacemaker during LSG acutely resulted in aberrant distal ectopic pacemaking or bioelectrical quiescence. Ectopic pacemaking can persist long after LSG, inducing chronic dysmotility. The clinical and therapeutic significance of these findings now require further investigation.
Gastric emptying scintigraphy for liquid and solid foods, before and 3 months after LSG.
36F/5 cm
After surgery, T1/2 was significantly accelerated: 15.2 ± 13 min and 33.5 ± 18 min in the L group and S group, respectively (). In both groups, GLP-1 plasma concentrations were increased at each blood sampling time: 2.91 ± 2.9 pg/mL, 3.06 ± 3.1 pg/mL, and 3.21 ± 2.6 pg/mL at 15, 30, and 60 minutes, respectively, () for the L group and 2.72 ± 1.5 pg/mL, 2.89 ± 2.1 pg/mL, 2.93 ± 1.8 pg/mL, and 2.95 ± 1.9 pg/mL at 30, 60, 90, and 120 minutes, respectively, () for the S group. After LSG, GLP-1 and %GR presented a negative linear correlation (r) at each blood sampling time in both groups. Rapid gastric emptying 3 months after LSG
Three groups were studied: morbidly obese patients (), morbidly obese patients who had had sleeve gastrectomy (), and nonobese patients ()
Gastric and gallbladder emptying
42F/5 cm
The antrum area during fasting in morbidly obese patients was statistically significantly larger than that in the nonobese and sleeve gastrectomy groups. Gastric emptying was accelerated in the sleeve gastrectomy group compared with the other 2 groups (which had very similar results). Gallbladder emptying was similar in the 3 groups. Gastric emptying was accelerated in the sleeve gastrectomy group compared with the other 2 groups (which had very similar results)
Tc-sulfur colloid GE scintigraphy was performed on all patients submitted to LSG before and after surgery (1–4 weeks for liquids and 4–6 weeks for solids)
36F/3–4 cm
T1/2 was significantly enhanced after LSG compared with the baseline (25.3 ± 4.4 versus 11.8 ± 3.0 min for liquids and 74.9 ± 7.1 versus 28.4 ± 8.3 min for solids, resp., ). The percentage of gastric retention in operated patients was significantly less than that at baseline for liquids at 15, 30, and 60 min (33.9 ± 5.6, 17.7 ± 3.9, and 7.5 ± 2.8% versus 69.4 ± 10.5, 55.6 ± 14.95, and 26.1 ± 4.7%, resp., ), as well as for solids at 30, 60, 90, and 120 min (42.0 ± 11.1, 20.8 ± 6.1, 11.0 ± 5.9, and 3.8 ± 2.7% versus 79.9 ± 8.7, 67.4 ± 12.2, 37.0 ± 10.9%, and 13.8 ± 4.4%, resp., ). The significant acceleration of GE of liquids and solids after LSG may have contributed to weight loss in the immediate postoperative period (4–6 weeks). It remains to be determined whether the weight loss will continue beyond that period.
Gastric emptying study with solid and liquid meal components in the second year after LSG
34F/6 cm
The lag phase (solid) was 6.4 ± 4.5 min in group I and 7.3 ± 6.3 in group II (); T1/2 (solid) was 40.6 ± 10.0 min in group I and 34.4 ± 9.3 in group II (); the caloric emptying rate was 3.9 ± 0.6 kcal/min in group I and 3.9 ± 1.0 kcal/min in group II (). Patients with postprandial symptoms after LSG reported more symptoms during the gastric emptying study than did patients without symptoms. However, there was no difference between gastric emptying characteristics between both groups, suggesting that abnormal gastric emptying is not a major determinant of postprandial symptoms after LSG.
45 Group A exam before (A1) and after the operation (A2). Control group (Group B)
Gastric emptying scintigraphy 1 month preoperatively and 3 months postoperatively
34Ch/4–5 cm
The scintigraphic study showed a reduced half-life tracer (A1 versus A2: 80.4 ± 16.5 min versus 64.3 ± 22 min ), without a significant difference. Comparing the two groups, no differences occurred before operation (B versus A1). The gastric emptying time resulted in a significant reduction in group A2 rather than in groups A1 and B. LSG reduces gastric emptying time
Group A antrum resection Group B Antrum preservation Gastric emptying scintigraphy before and 3 months postoperatively
42F/7cm
In the antrum resection group, the average time T1/2 declined from 57.5 to 32.25 min () and average retention %GE dropped from 20.5 to 9.5% (). In the antrum resection group, an increase in gastric emptying postoperatively was noted. Complications such as failure of stomach evacuation were not observed in the RA group; even more radical resection of the pyloric antrum performed by LSG is possible without concerns of postoperative disorder of the stomach evacuation function
Data from an institutional review board-approved electronic registry
62
Gastroduodenal transit time (antrum to duodenum) was calculated from a postoperative day 1 esophagram. Postoperative esophagrams
40F/5–7 cm
The mean gastroduodenal transit time was 12.3 ± 19.8 s. Almost all patients (99%) had a transit time of less than 60 s. No correlation was found between gastroduodenal transit time and %EWL at 3, 6, or 12 months.
MRI 1 day before LSG and 6 days and 6 months after LSG
32F/5–6 cm
The dynamic analysis showed that antral propulsive peristalsis was preserved immediately after surgery and during follow-up, but fold speed increased significantly from 2.7 mm/s before LSG to 4.4 mm/s after 6 months. The sleeve itself remained without recognizable peristalsis in three patients and showed only uncoordinated or passive motion in two patients. Consequently, the fluid transport through the sleeve was markedly delayed, whereas the antrum showed accelerated propulsion with the emptying half-time decreasing from 16.5 min preoperatively to 7.9 min 6 months after surgery. The stomach is functionally divided into a sleeve without propulsive peristalsis and an accelerated antrum. Accelerated emptying seems to be caused by faster peristaltic folds.
The size of the gastric fundus remaining after LSG and gastric voiding rate (fast/slow) by radiological upper gastrointestinal series (UGS) with a water-soluble contrast medium (CM).
NR/4–6 cm
Sleeve voiding was fast in 49 of 57 patients (85.96%) and slow in eight (14.03%). Patients showing a rapid gastroduodenal transit of the CM achieved a better weight loss than patients with a slow voiding rate.
24 were lean controls (body mass index 22.2 ± 2.84 kg/m (2)), 20 were severely and morbidly obese patients with T2DM who had not undergone SG (body mass index 37.73 ± 5.35 kg/m (2)), and 23 were severely and morbidly obese patients with T2DM after SG.
Scintigraphic imaging with g-camera
NR
The gastric emptying half-time values were also significantly shorter () in the post-SG (52.8 ± 13.5 minutes) than in the non-SG (73.7 ± 29.0 minutes) and control (72.8 ± 29.6 minutes) groups decreased gastric emptying half-time after SG
Gastric emptying of liquids and solids was measured by scintigraphic technique 3 months postoperatively.
32F/2 cm
In the group of operated patients, 70% of them () presented accelerated emptying for liquids and 75% () for solids compared to 22.2% and 27.7%, respectively, in the control group. The half-time of gastric emptying (T(1/2)) in patients submitted to SG both for liquids and solids were significantly more accelerated compared to the control group (34.9 ± 24.6 versus 13.6 ± 11.9 min for liquids and 78 ± 15.01 versus 38.3 ± 18.77 min for solids; ). The gastric emptying for liquids expressed as the percentages of retention at 20, 30, and 60 min were 30.0 ± 0.25%, 15.4 ± 0.18%, and 5.7 ± 0.10%, respectively, in operated patients, significantly less than the control subjects (). For solids, the percentage of retention at 60, 90, and 120 min was 56 +/− 28%, 34 +/− 22%, and 12 +/− 8%, respectively, for controls, while it was 25.3 +/− 0.20%, 9 +/− 0.12%, and 3 +/− 0.05%, respectively, in operated patients (). Gastric emptying after SG is accelerated either for liquids as well as for solids in the majority of patients.
Gastric emptying scintigraphy of semisolids was performed before and 3 months after LSG
48F/6 cm
The mean T 1/2 raw data were 62.39 ± 19.83 and 56.79 ± 18.72 min (,, NS) before and 3 months after LSG, respectively. The T 1/2 linear was 103.64 ± 9.82 and 106.92 ± 14.55, (,, NS), and the linear fit slope 0.48 ± 0.04 and 0.47 ± 0.05 (,, NS). LSG with antrum preservation as performed in this series has no effect on gastric emptying.
Nine patients underwent gastric emptying studies, using radioisotopic technique before, 6 months, and 24 months after the operation. The remaining five patients underwent gastric emptying studies, 6 months and 24 months after the operation. Scintigraphic imaging was performed with a γ-camera
NR
In the nine patients who underwent gastric emptying studies preoperatively and 6 and 24 months postoperatively, the T-lag phase duration significantly decreased, following the SG, from 17.30 (range 15.50–20.90) min, to 12.50 (range 9.20–18.00) min at 6 months and 12.16 (range 10.90–20.00) min at 24 months postoperatively () The gastric emptying half time (T1/2) accelerated significantly postoperatively from 86.50 (range 77.50–104.60) min, to 62.50 (range 46.30–80.00) min at 6 months and 60.80 (range 54.80–100.00) min at 24 months after SG (). The percentage of gastric emptying (%GE) increased significantly postoperatively, from 52 (range 43–58) % to 72 (range 57–97) % at 6 months and 74 (range 45–82) % at 24 months, following SG (). No differences in gastric emptying were observed, when values at 24 months were compared to those at 6 months postoperatively. When the whole group of 14 patients was studied, there were also no significant changes in T-lag, T1/2 and %GE between 6 and 24 months postoperatively. Constant effect of SG in the acceleration of gastric emptying of solids, which occurs faster, not only in short but also in long-term postoperatively
The scintigraphic measurement of the gastric emptying of a solid meal preoperatively and 6 months postoperatively. Gastric emptying studies using radioisotopic technique before and 6 months after the operation.
34F/7 cm
Although the meal size was drastically reduced, the meal frequency increased postoperatively in 12 patients (52.2%). Only 5 patients (21.8%) reported occasional vomiting after meals following SG. The gastric emptying half-time (T1/2) accelerated (47.6 ± 23.2 versus 94.3 ± 15.4, ), and the T-lag phase duration decreased (9.5 ± 2 min versus 19.2 ± 2 min, ) postoperatively. The percentage of the meal emptied from the stomach 90 min after consumption increased significantly after SG (75.4 ± 14.9% versus 49.2 ± 8.7%, ); the stomach empties its contents rapidly into the small intestine and symptoms of vomiting after eating (characteristic of restrictive procedures) are either absent or very mild
