Delayed Gastric Emptying After Sleeve Gastrectomy Is Associated with Poor Weight Loss.

Autor: Wickremasinghe AC; Department of Surgery, Central Clinical School, Alfred Centre, Monash University, Level 6, 99 Commercial Rd, VIC, 3004, Melbourne, Australia. anagi.wickremasinghe@monash.edu., Johari Y; Department of Surgery, Central Clinical School, Alfred Centre, Monash University, Level 6, 99 Commercial Rd, VIC, 3004, Melbourne, Australia.; Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, VIC, 3004, Australia., Laurie C; Department of Surgery, Central Clinical School, Alfred Centre, Monash University, Level 6, 99 Commercial Rd, VIC, 3004, Melbourne, Australia., Shaw K; Department of Surgery, Central Clinical School, Alfred Centre, Monash University, Level 6, 99 Commercial Rd, VIC, 3004, Melbourne, Australia.; Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, VIC, 3004, Australia., Playfair J; Department of Surgery, Central Clinical School, Alfred Centre, Monash University, Level 6, 99 Commercial Rd, VIC, 3004, Melbourne, Australia., Beech P; Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, VIC, 3004, Australia., Yue H; Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, VIC, 3004, Australia., Becroft L; Department of Surgery, Central Clinical School, Alfred Centre, Monash University, Level 6, 99 Commercial Rd, VIC, 3004, Melbourne, Australia.; Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, VIC, 3004, Australia., Hebbard G; Department of Gastroenterology, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, 3050, Australia., Yap KS; Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, VIC, 3004, Australia.; Department of Medicine, Monash University, Alfred Hospital Campus, Melbourne, VIC, 3004, Australia., Brown W; Department of Surgery, Central Clinical School, Alfred Centre, Monash University, Level 6, 99 Commercial Rd, VIC, 3004, Melbourne, Australia.; Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, VIC, 3004, Australia., Burton P; Department of Surgery, Central Clinical School, Alfred Centre, Monash University, Level 6, 99 Commercial Rd, VIC, 3004, Melbourne, Australia.; Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, VIC, 3004, Australia.
Jazyk: angličtina
Zdroj: Obesity surgery [Obes Surg] 2022 Dec; Vol. 32 (12), pp. 3922-3931. Date of Electronic Publication: 2022 Oct 27.
DOI: 10.1007/s11695-022-06323-2
Abstrakt: Background: Intermediate to long-term weight regain is a major challenge following sleeve gastrectomy (SG). Physiological changes that mediate the extent of weight loss remain unclear. We aimed to determine if there were specific esophago-gastric transit and emptying alterations associated with weight regain.
Material and Methods: Participants greater than 12 months post-SG were categorized into optimal (n = 29) and poor weight loss (PWL) (n = 72). All patients underwent a liquid contrast barium swallow demonstrating normal post-surgical anatomy and a protocolized nuclear scintigraphy designed specifically to characterize gastric emptying following SG.
Results: The %total weight loss in the optimal group was 26.2 ± 10.5 vs. 14.3 ± 8.8% in the PWL group (p = 0.001). Scintigraphy showed PWL had relatively increased gastric emptying half-time (GE 1/2t ) 35 (IQR 23) min vs 19 (IQR 5.5) min (p = 0.001). The multivariate regressions delineated GE 1/2t as the best diagnostic measure for PWL (OR 1.16; CI 1.04-1.29, p-value 0.021). The probability of PWL increased by 16% for every 1-min increase above 21 min of GE 1/2t . A threshold of 21 min was found to have 88% sensitivity and 69% specificity predicting poor weight loss.
Conclusion: Gastric emptying half-times greater than 21 min appear to reliably correlate with poor weight loss following SG. Additionally, further elevations above 21 min in emptying half-time increase the risk of poor weight loss. We have shown nuclear scintigraphy represents a simple and accurate diagnostic tool in patients who experience poor weight loss after SG, provided substantially altered reporting references in interpreting nuclear scintigraphy are applied.
(© 2022. The Author(s).)
Databáze: MEDLINE
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