Comparative assessment of gastric emptying in obese patients before and after laparoscopic sleeve gastrectomy using radionuclide scintigraphy

Abstract

Radionuclide scintigraphy provides a standard physiologic evaluation of gastric emptying (GE) after laparoscopic sleeve gastrectomy (LSG). This operation can be associated with motor gastric dysfunction and abnormal GE. The aim of this study was to evaluate the short-term effect of LSG on GE quantitative indices for liquids and solids compared with preoperative results. Forty obese patients were divided into two equal groups, the liquid and solid groups. 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). The quantitative indices included half emptying time (T1/2) and percentage gastric retention at 15, 30, and 60 min for liquids and at 30, 60, 90, and 120 min for solids. A modified technique was used to label a boiled egg in order to be tolerated by the patients. T1/2 was significantly enhanced after LSG compared with baseline (25.3±4.4 vs. 11.8±3.0 min for liquids and 74.9±7.1 vs. 28.4±8.3 min for solids, respectively, P<0.001). 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% vs. 69.4±10.5, 55.6±14.95, and 26.1±4.7%, respectively, P<0.001), 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% vs. 79.9±8.7, 67.4±12.2, 37.0±10.9%, and 13.8±4.4%, respectively, P<0.001). 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.

Diet approach before and after bariatric surgery

“…However, RYGB was associated with more severe hypoglycemic episodes and RYGB patients had an overall larger number of reactive hypoglycemic episodes than SG. This fact was explained by the postprandial hyperinsulinemia observed after RYGB, inappropriately high despite glucose levels, and not by gastric empting, described to be equally accelerated after both RYGB and SG [52]. A study comparing matched controls to RYGB surgical patients with and without symptomatic hypoglycemia, shown that glucagon-like peptide 1 (GLP-1) had effect on insulin secretion only in RYGB patients, both symptomatic and asymptomatic.…”

Impact of Laparoscopic Sleeve Gastrectomy on Gastrointestinal Motility

“…Eighteen studies assessed stomach motility. Eleven studies were conducted in Europe (Spain [ n = 2] [ 14 , 15 ], Italy [ n = 3] [ 16 – 18 ], Greece [ n = 3] [ 19 – 21 ], Czech Republic [ n = 1] [ 22 ], Germany [ n = 1] [ 23 ], and the Netherlands [ n = 1] [ 24 ]), whereas one study was performed in the USA [ 25 ], two studies in India [ 26 , 27 ], one study in New Zealand [ 28 ], one in Egypt [ 29 ], one in Chile [ 30 ], and one in Israel [ 31 ]. Twelve studies were prospective studies, four studies were prospective randomized controlled studies [ 14 , 17 , 22 , 27 ], and two were retrospective studies [ 18 , 25 ].…”

Consecuencias fisiopatológicas y anatómicas posgastrectomía vertical tubular como posibles causas de enfermedad por reflujo gastroesofágico

“…Existe acuerdo entre la mayoría de los autores que confirman que el vaciamiento gástrico es acelerado después de GVT. Melissas y nosotros mismos informamos un vaciamiento gástrico más rápido para sólidos y líquidos 12,[39][40][41][42][43][44]. Por el contrario, Bernstine 45 no confirmó los mismos hallazgos para una comida semisólida sugiriendo que el vaciamiento gástrico no se ve afectado después de la GVT con preservación del antro.…”