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Patterns of Abnormal Gastric Pacemaking After Sleeve Gastrectomy Defined by Laparoscopic High-Resolution Electrical Mapping

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Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is increasingly being applied to treat obesity. LSG includes excision of the normal gastric pacemaker, which could induce electrical dysrhythmias impacting on post-operative symptoms and recovery, but these implications have not been adequately investigated. This study aimed to define the effects of LSG on gastric slow-wave pacemaking using laparoscopic high-resolution (HR) electrical mapping.

Methods

Laparoscopic HR mapping was performed before and after LSG using flexible printed circuit arrays (64–96 electrodes; 8–12 cm2; n = 8 patients) deployed through a 12 mm trocar and positioned on the gastric serosa. An additional patient with chronic reflux, nausea, and dysmotility 6 months after LSG also underwent gastric mapping while undergoing conversion to gastric bypass. Slow-wave activity was quantified by propagation pattern, frequency, velocity, and amplitude.

Results

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%). Propagation velocity was abnormally rapid after LSG (12.5 ± 0.8 vs baseline 3.8 ± 0.8 mm s−1; p = 0.01), whereas frequency and amplitude were unchanged (2.7 ± 0.3 vs 2.8 ± 0.3 cpm, p = 0.7; 1.7 ± 0.2 vs 1.6 ± 0.6 mV, p = 0.7). 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).

Conclusion

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.

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Acknowledgements

The authors thank Mr. Andrew MacCormick, Mr. Nicholas Evernett, and surgical staff for help with data collection.

Author information

Authors and Affiliations

  1. Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand

    Rachel Berry, Leo K. Cheng, Peng Du, Niranchan Paskaranandavadivel, Timothy R. Angeli, Terence Mayne & Gregory O’Grady

  2. Department of Surgery, Vanderbilt University, Nashville, TN, USA

    Leo K. Cheng

  3. Department of Surgery, Auckland City Hospital, Auckland, New Zealand

    Grant Beban

  4. Department of Surgery, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand

    Gregory O’Grady

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  1. Rachel Berry
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Correspondence to Gregory O’Grady.

Ethics declarations

Ethical approval for this work was granted by the Health and Disability Ethics Committee, New Zealand.

Funding

This project and research team were funded by research grants from the NZ Health Research Council (HRC), the US NIH (R01 DK64775), and the NZ MedTech CoRE. RB was supported by a Commonwealth Scholarship and PD by a Rutherford Discovery Fellowship.

Conflict of Interest

GOG, PD, NP, TRA, and LKC hold intellectual property in the field of gastric electrophysiology and are shareholders in FlexiMap. RB, TM, and GB declare no conflicts of interest. No commercial or industry financial support was provided for this study.

Ethical Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Berry, R., Cheng, L.K., Du, P. et al. Patterns of Abnormal Gastric Pacemaking After Sleeve Gastrectomy Defined by Laparoscopic High-Resolution Electrical Mapping. OBES SURG 27, 1929–1937 (2017). https://doi.org/10.1007/s11695-017-2597-6

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  • DOI: https://doi.org/10.1007/s11695-017-2597-6

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