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Manometry of the Upper Gut Following Roux-en-Y Gastric Bypass Indicates That the Gastric Pouch and Roux Limb Act as a Common Cavity

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Abstract

Background

The motility of the upper gut after Roux-en-Y gastric bypass (RYGBP) is underexplored. We aimed to investigate the oesophago-gastro-Roux limb motor activity during fasting and after food intake.

Methods

Eighteen morbidly obese patients were examined at least 2 years after RYGBP. A high-resolution manometry catheter was positioned to straddle the oesophagogastric junction, the gastric pouch and the proximal Roux limb using transmucosal potential difference measurements. Three patients with vertical banded gastroplasty (VBG) were also studied.

Results

During the fasting state, the gastric pouch had low or no activity whereas the Roux limb exhibited regular migrating motility complexes (MMCs) being initiated just distal to gastroenteroanastomosis. Median cycle duration was 72 min, and the median propagating velocity of the phase III MMC phase was 2.7 cm/min (n = 8). When patients were asked to eat until they felt comfortably full, intraluminal pressure increased by 6 to 8 cmH2O without any significant difference between gastric pouch and the Roux limb (n = 9). The increased intraluminal pressure following food intake correlated neither to weight loss nor to meal size or rate of eating.

Conclusions

A successful RYGBP is associated with MMC in the Roux limb during fasting. The gastric pouch and the Roux limb behaved as a common cavity during food ingestion. Data do not support the hypothesis that the alimentary limb pressure in response to food intake influences either meal size or weight loss.

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Acknowledgments

The authors acknowledge My Engström and Niclas Björnfot (research nurses), as well as Sören Lundberg (research engineer), for skilful assistance at clinical examinations and data analysis.

Conflicts of Interest

Dr. Lönroth has received an unrestricted research grant from Johnson & Johnson Ethicon Surgical Care. Drs. Björklund and Fändriks declare that they have no conflict of interest.

Funding

Financial support was obtained from the Sahlgrenska University Hospital ALF grants and from the Gothenburg Medical Association.

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Authors and Affiliations

  1. Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Per Björklund, Hans Lönroth & Lars Fändriks

  2. Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden

    Lars Fändriks

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  1. Per Björklund
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Correspondence to Lars Fändriks.

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Björklund, P., Lönroth, H. & Fändriks, L. Manometry of the Upper Gut Following Roux-en-Y Gastric Bypass Indicates That the Gastric Pouch and Roux Limb Act as a Common Cavity. OBES SURG 25, 1833–1841 (2015). https://doi.org/10.1007/s11695-015-1639-1

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