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Erschienen in: Obesity Surgery 11/2009

01.11.2009 | Clinical Research

Scintigraphic Evaluation of Gastric Emptying in Obese Patients Submitted to Sleeve Gastrectomy Compared to Normal Subjects

verfasst von: Italo Braghetto, Cristóbal Davanzo, Owen Korn, Attila Csendes, Héctor Valladares, Eduardo Herrera, Patricio Gonzalez, Karin Papapietro

Erschienen in: Obesity Surgery | Ausgabe 11/2009

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Abstract

Background

Sleeve gastrectomy (SG) has been accepted as an option for surgical treatment for obesity. This operation could be associated with motor gastric dysfunction and abnormal gastric emptying. The purpose of this prospective study is to present the results of gastric emptying to liquids and solids using scintigraphy in patients who underwent SG compared to normal subjects.

Methods

Twenty obese patients were submitted to laparoscopic SG and were compared to 18 normal subjects. Gastric emptying of liquids and solids was measured by scintigraphic technique. Results were expressed as half time of gastric emptying and the percentage of retention at 20, 30, and 60 min for liquids and at 60, 90, and 120 min for solids.

Results

In the group of operated patients, 70% of them (n = 14) presented accelerated emptying for liquids and 75% (n = 15) 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 vs 13.6 ± 11.9 min for liquids and 78 ± 15.01 vs 38.3 ± 18.77 min for solids; p < 0.01). The gastric emptying for liquids expressed as the percentage of retention at 20, 30, and 60 min was 30.0 ± 0.25%, 15.4 ± 0.18%, and 5.7 ± 0.10%, respectively, in operated patients, significantly less than the control subjects (p < 0.001). 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 (p < 001).

Conclusions

Gastric emptying after SG is accelerated either for liquids as well as for solids in the majority of patients. These results could be taken in consideration for the dietary indications after surgery and could play a significant role in the definitive results during the late follow-up.
Literatur
1.
Zurück zum Zitat Verdich C, Madsen JL, Toubro S, et al. Effect of obesity and major weight reduction on gastric emptying. Int J Obes. 2000;24:899–905.CrossRef Verdich C, Madsen JL, Toubro S, et al. Effect of obesity and major weight reduction on gastric emptying. Int J Obes. 2000;24:899–905.CrossRef
2.
Zurück zum Zitat Gallagher TK, Geoghegan JG, Baird AW, Winter DC. Implications of altered gastrointestinal motility in obesity. Obes Surg. 2007;17:1399–407.CrossRef Gallagher TK, Geoghegan JG, Baird AW, Winter DC. Implications of altered gastrointestinal motility in obesity. Obes Surg. 2007;17:1399–407.CrossRef
3.
Zurück zum Zitat Csendes A, Burdiles P, Braghetto I, et al. Early and late results of the acid suppression and duodenal diversion operation in patient with Barrett's esophagus: analysis of 210 cases. World J Surg. 2002;26:566–76.CrossRef Csendes A, Burdiles P, Braghetto I, et al. Early and late results of the acid suppression and duodenal diversion operation in patient with Barrett's esophagus: analysis of 210 cases. World J Surg. 2002;26:566–76.CrossRef
4.
Zurück zum Zitat Hinder RA, Esser J, DeMeester TR. Management of gastric emptying disorders following the Roux-en-Y procedure. Surgery. 1988;104:765–72.PubMed Hinder RA, Esser J, DeMeester TR. Management of gastric emptying disorders following the Roux-en-Y procedure. Surgery. 1988;104:765–72.PubMed
5.
Zurück zum Zitat Miedema BW, Kelly KA. The Roux operation for postgastrectomy syndromes. Am J Surg. 1991;161:256–61.CrossRef Miedema BW, Kelly KA. The Roux operation for postgastrectomy syndromes. Am J Surg. 1991;161:256–61.CrossRef
6.
Zurück zum Zitat Horowitz M, Cook DJ, Collins PE, et al. Measurement of gastric emptying after gastric bypass surgery using radionuclides. Br J Surg. 1982;69:655–7.CrossRef Horowitz M, Cook DJ, Collins PE, et al. Measurement of gastric emptying after gastric bypass surgery using radionuclides. Br J Surg. 1982;69:655–7.CrossRef
7.
Zurück zum Zitat Horowitz M, Collins PJ, Chatterton BE, et al. Gastric emptying after gastroplasty for morbid obesity. Br J Surg. 1984;71:435–7.CrossRef Horowitz M, Collins PJ, Chatterton BE, et al. Gastric emptying after gastroplasty for morbid obesity. Br J Surg. 1984;71:435–7.CrossRef
8.
Zurück zum Zitat Bennett J, Rhodes M, Malcom P, et al. Assessment of the relationship between postmeal satiety, gastric volume and gastric emptying after Swedish adjustable gastric banding. A pilot study using magnetic resonance imaging to assess postsurgery gastric function. Obes Surg. 2008;19:757–63.CrossRef Bennett J, Rhodes M, Malcom P, et al. Assessment of the relationship between postmeal satiety, gastric volume and gastric emptying after Swedish adjustable gastric banding. A pilot study using magnetic resonance imaging to assess postsurgery gastric function. Obes Surg. 2008;19:757–63.CrossRef
9.
Zurück zum Zitat de Jong JR, van Ramshorst B, Gooszen HG, et al. Weight loss after laparoscopic adjustable gastric banding is not caused by altered gastric emptying. Obes Surg. 2008;19:287–92.CrossRef de Jong JR, van Ramshorst B, Gooszen HG, et al. Weight loss after laparoscopic adjustable gastric banding is not caused by altered gastric emptying. Obes Surg. 2008;19:287–92.CrossRef
10.
Zurück zum Zitat Lacy BE, Weiser K. Gastric motility, gastroparesis and gastric stimulation. Surg Clin N Am. 2005;85:967–87.CrossRef Lacy BE, Weiser K. Gastric motility, gastroparesis and gastric stimulation. Surg Clin N Am. 2005;85:967–87.CrossRef
11.
Zurück zum Zitat Sanjeevi A. Gastric motility. Curr Opin Gastroenterol. 2007;23:625–30.CrossRef Sanjeevi A. Gastric motility. Curr Opin Gastroenterol. 2007;23:625–30.CrossRef
12.
Zurück zum Zitat Braghetto I, Korn O, Valladares H, et al. Laparoscopic sleeve gastrectomy: surgical technique, indications and clinical results. Obes Surg. 2007;17:1442–50.CrossRef Braghetto I, Korn O, Valladares H, et al. Laparoscopic sleeve gastrectomy: surgical technique, indications and clinical results. Obes Surg. 2007;17:1442–50.CrossRef
13.
Zurück zum Zitat Lillo R, Jouanne E, Gonzalez P, et al. Vaciamiento gástrico: Comparacion de valores normales para diferentes proyecciones par alimentos sólidos y líquidos. Rev Esp Med Nucl. 1995;12:263 (A). Lillo R, Jouanne E, Gonzalez P, et al. Vaciamiento gástrico: Comparacion de valores normales para diferentes proyecciones par alimentos sólidos y líquidos. Rev Esp Med Nucl. 1995;12:263 (A).
14.
Zurück zum Zitat Tack J. Gastric motor disorders. Best Pract Res Clin Gastroenterol. 2007;21:633–44.CrossRef Tack J. Gastric motor disorders. Best Pract Res Clin Gastroenterol. 2007;21:633–44.CrossRef
15.
Zurück zum Zitat Cardoso-Junior A, Vaz Coelho LG, Savassi-Rocha PR, et al. Gastric emptying of solis and semisolids in morbid obese and non obese subjects: an assessment using the 13 C-octanoic acid and 13C-acetic acid breath test. Obes Surg. 2007;17:236–41.CrossRef Cardoso-Junior A, Vaz Coelho LG, Savassi-Rocha PR, et al. Gastric emptying of solis and semisolids in morbid obese and non obese subjects: an assessment using the 13 C-octanoic acid and 13C-acetic acid breath test. Obes Surg. 2007;17:236–41.CrossRef
16.
Zurück zum Zitat Gryback P, Naslund E, Helstrom PM, et al. Gastric emptying of solids in humans, improved evaluation by Kaplan–Meier plots, with special reference to obesity and gender. Eur J Nucl Med Mol Imaging. 1996;23:1562–7.CrossRef Gryback P, Naslund E, Helstrom PM, et al. Gastric emptying of solids in humans, improved evaluation by Kaplan–Meier plots, with special reference to obesity and gender. Eur J Nucl Med Mol Imaging. 1996;23:1562–7.CrossRef
17.
Zurück zum Zitat Horowicz M, Collins PJ, Cook DJ, et al. Abnormalities of gastric emptying in obese patients. Int J Obes. 1983;7:415–21. Horowicz M, Collins PJ, Cook DJ, et al. Abnormalities of gastric emptying in obese patients. Int J Obes. 1983;7:415–21.
18.
Zurück zum Zitat Jackson SJ, Leathy FE, McGowan AA, et al. Delayed gastric emptying in the obese: an assessment using non invasive (13)C-octanoic acid breath test. Diabetes Obes Metab. 2004;6:264–70.CrossRef Jackson SJ, Leathy FE, McGowan AA, et al. Delayed gastric emptying in the obese: an assessment using non invasive (13)C-octanoic acid breath test. Diabetes Obes Metab. 2004;6:264–70.CrossRef
19.
Zurück zum Zitat Maddox A, Horowicz M, Wishart J, et al. Gastric and esophageal emptying in obesity. Scand J Gastroenterol. 1989;24:593–8.CrossRef Maddox A, Horowicz M, Wishart J, et al. Gastric and esophageal emptying in obesity. Scand J Gastroenterol. 1989;24:593–8.CrossRef
20.
Zurück zum Zitat Wright RA, Krinsky S, Fleeman C, et al. Gastric emptying and obesity. Gastroenterology. 1983;84:747–51.PubMed Wright RA, Krinsky S, Fleeman C, et al. Gastric emptying and obesity. Gastroenterology. 1983;84:747–51.PubMed
21.
Zurück zum Zitat Xing J, Chen JDZ. Alterations of gastrointestinal motility in obesity. Obes Res. 2004;12:1723–32.CrossRef Xing J, Chen JDZ. Alterations of gastrointestinal motility in obesity. Obes Res. 2004;12:1723–32.CrossRef
22.
Zurück zum Zitat Tosetti C, Corinaldesi R, Stanghellini V, et al. Gastric emptying of solids in morbid obesity. Int J Obes Relat Metab Disord. 1996;20:200–5.PubMed Tosetti C, Corinaldesi R, Stanghellini V, et al. Gastric emptying of solids in morbid obesity. Int J Obes Relat Metab Disord. 1996;20:200–5.PubMed
23.
Zurück zum Zitat Hinder RA, Kelly K. Human gastric pacesetter potential. Site of origin, spread and response to gastric transection or proximal vagotomy. Am J Surg. 1977;133:29–33.CrossRef Hinder RA, Kelly K. Human gastric pacesetter potential. Site of origin, spread and response to gastric transection or proximal vagotomy. Am J Surg. 1977;133:29–33.CrossRef
24.
Zurück zum Zitat Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gastrectomy—a food “limiting” operation. Obes Surg. 2008;18:1251–6.CrossRef Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gastrectomy—a food “limiting” operation. Obes Surg. 2008;18:1251–6.CrossRef
25.
Zurück zum Zitat Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy—a restrictive procedure? Obes Surg. 2007;17:57–62.CrossRef Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy—a restrictive procedure? Obes Surg. 2007;17:57–62.CrossRef
26.
Zurück zum Zitat Bernstine H, Tzioni_Yehoshua R, Groshar D, et al. Gastric emptying is nor affected by sleeve gastrectomy—scintigraphic evaluation of gastric emptying after Sleeve gastrectomy without removal of the gastric Antrum. Obes Surg. 2009;19:293–8.CrossRef Bernstine H, Tzioni_Yehoshua R, Groshar D, et al. Gastric emptying is nor affected by sleeve gastrectomy—scintigraphic evaluation of gastric emptying after Sleeve gastrectomy without removal of the gastric Antrum. Obes Surg. 2009;19:293–8.CrossRef
27.
Zurück zum Zitat Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg. 2008;18:1083–8.CrossRef Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg. 2008;18:1083–8.CrossRef
28.
Zurück zum Zitat Rubin M, Yehoshua RT. The role of the various factros contributing to the redfuction of food intake following sleeve gastrectomy. Proceedings of the 2nd Annual International Consensus Summit for Sleeve Gastrectomy ICSSG-2 Miami, March 2009 Rubin M, Yehoshua RT. The role of the various factros contributing to the redfuction of food intake following sleeve gastrectomy. Proceedings of the 2nd Annual International Consensus Summit for Sleeve Gastrectomy ICSSG-2 Miami, March 2009
29.
Zurück zum Zitat Altuve J, Gonzales R, Aceituno L. Does sleeve gastrectomy really avoid dumping syndrome? Proceedings of the 2nd Annual International Consensus Summit for Sleeve gastrectomy ICSSG-2 Miami, March 2009 Altuve J, Gonzales R, Aceituno L. Does sleeve gastrectomy really avoid dumping syndrome? Proceedings of the 2nd Annual International Consensus Summit for Sleeve gastrectomy ICSSG-2 Miami, March 2009
30.
Zurück zum Zitat Van Hee R, Mistiaen W, Block P. Gastric emptying of liquids after highly selective vagotomy for duodenal ulcer. Hepatogastroenterology. 1989;36:92–6.PubMed Van Hee R, Mistiaen W, Block P. Gastric emptying of liquids after highly selective vagotomy for duodenal ulcer. Hepatogastroenterology. 1989;36:92–6.PubMed
31.
Zurück zum Zitat Mistiaen W, Van Hee R, Blockx P, et al. Gastric emptying for solids in patients with duodenal ulcer before and after highly selective vagotomy. Am Surg. 1985;51:690–2. Mistiaen W, Van Hee R, Blockx P, et al. Gastric emptying for solids in patients with duodenal ulcer before and after highly selective vagotomy. Am Surg. 1985;51:690–2.
32.
Zurück zum Zitat Morioka J. Gastric emptying for liquids and solids after distal gastrectomy with Billroth I reconstruction. Hepatogastroenterolgy. 2008;55:1136–9. Morioka J. Gastric emptying for liquids and solids after distal gastrectomy with Billroth I reconstruction. Hepatogastroenterolgy. 2008;55:1136–9.
33.
Zurück zum Zitat Woodward ER, Hocking MP. Postgastrectomy syndromes. Surg Clin N Am. 1987;67:509–20.CrossRef Woodward ER, Hocking MP. Postgastrectomy syndromes. Surg Clin N Am. 1987;67:509–20.CrossRef
34.
Zurück zum Zitat Pereferrer FS, Gonzalez MH, Rovira AV, et al. Influence of sleeve gastrectomy in several experimental model of obesity: metabolic and hormonal implications. Obes Surg. 2008;18:97–108.CrossRef Pereferrer FS, Gonzalez MH, Rovira AV, et al. Influence of sleeve gastrectomy in several experimental model of obesity: metabolic and hormonal implications. Obes Surg. 2008;18:97–108.CrossRef
35.
Zurück zum Zitat Santoro S, Milleo FO, Malzoni CE, et al. Enterohormonal changes after digestive adaptation. Five years results of surgical proposal to treat obesity and associated diseases. Obes Surg. 2008;18:17–26.CrossRef Santoro S, Milleo FO, Malzoni CE, et al. Enterohormonal changes after digestive adaptation. Five years results of surgical proposal to treat obesity and associated diseases. Obes Surg. 2008;18:17–26.CrossRef
36.
Zurück zum Zitat Vidal J, Ibarzabal A, Romero F, et al. Type 2 diabetes mellitus and metabolic syndrome following sleeve gastrectomy in severely obese subjects. Obes Surg. 2008;18:1077–82.CrossRef Vidal J, Ibarzabal A, Romero F, et al. Type 2 diabetes mellitus and metabolic syndrome following sleeve gastrectomy in severely obese subjects. Obes Surg. 2008;18:1077–82.CrossRef
37.
Zurück zum Zitat Cardoso-Junior A, Savassi-Rocha PR, Coelho LGV, et al. Botulinum A toxin injected into gastric wall for treatment of morbid obesity: a pilot study. Obes Surg. 2006;16:335–43.CrossRef Cardoso-Junior A, Savassi-Rocha PR, Coelho LGV, et al. Botulinum A toxin injected into gastric wall for treatment of morbid obesity: a pilot study. Obes Surg. 2006;16:335–43.CrossRef
38.
Zurück zum Zitat Moon-In P, Camilleri M. Gastric motor and sensory function in obesity. Obes Res. 2005;13:481–500. Moon-In P, Camilleri M. Gastric motor and sensory function in obesity. Obes Res. 2005;13:481–500.
39.
Zurück zum Zitat Mason EE. Editorial. Gastric emptying controls type 2 diabetes mellitus. Obes Surg. 2007;17:853–5.CrossRef Mason EE. Editorial. Gastric emptying controls type 2 diabetes mellitus. Obes Surg. 2007;17:853–5.CrossRef
40.
Zurück zum Zitat Reza LFB, Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15:1024.CrossRef Reza LFB, Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15:1024.CrossRef
41.
Zurück zum Zitat Cohen R, Uzzan B, Biham H, et al. Ghrelin level and sleeve gastrectomy in superobesity. Obes Surg. 2005;15:1501–2.CrossRef Cohen R, Uzzan B, Biham H, et al. Ghrelin level and sleeve gastrectomy in superobesity. Obes Surg. 2005;15:1501–2.CrossRef
42.
Zurück zum Zitat Deitel M, Crosby RD, Gagner M. The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18:487–96.CrossRef Deitel M, Crosby RD, Gagner M. The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18:487–96.CrossRef
Metadaten
Titel
Scintigraphic Evaluation of Gastric Emptying in Obese Patients Submitted to Sleeve Gastrectomy Compared to Normal Subjects
verfasst von
Italo Braghetto
Cristóbal Davanzo
Owen Korn
Attila Csendes
Héctor Valladares
Eduardo Herrera
Patricio Gonzalez
Karin Papapietro
Publikationsdatum
01.11.2009
Verlag
Springer New York
Erschienen in
Obesity Surgery / Ausgabe 11/2009
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-009-9954-z

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