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Expected Values of Esophageal Transit and Gastric Emptying Scintigraphy Post-uncomplicated Sleeve Gastrectomy

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Abstract

Purpose

Sleeve gastrectomy (SG) results in significant anatomical and physiological alterations of the esophagus and stomach, including food tolerance. Currently, there is no consensus on the parameters of abnormal esophageal transit and gastric emptying in this population. We describe standardized esophageal transit and gastric emptying protocols, and define expected values following an uncomplicated SG.

Materials and Methods

In 43 asymptomatic post-SG patients with optimal weight loss, a standardized liquid and semi-solid (oatmeal) esophageal transit study, plus a 90-min semi-solid gastric emptying study with dynamic 5-s image acquisition to assess gastroesophageal reflux, was performed. Gastric emptying half-time and retention rate was calculated. Esophageal transit and reflux were graded by visual inspection of images.

Results

Thirty-one female and 12 male patients participated: mean age 49.0±10.7 years, pre-operative BMI 47.6±7.0 kg/m2, excess weight loss 58.8±26.0% at median follow-up of 7.4 months. The standardized semi-solid meal and liquid preparations were well tolerated. Delays in esophageal transit of liquid and semi-solid boluses were infrequent (7.0% and 16.3% respectively). Deglutitive reflux of both semi-solids and liquids was common (48.8% and 32.6%). The median semi-solid gastric emptying half-time was 21.0 min. A large proportion of substrate transited into the small bowel on initial image acquisition (median 39.1%). Reflux events during gastric emptying were common (median 5.0 events, 12.7% of image acquisition time).

Conclusions

Rapid gastric emptying with asymptomatic deglutitive and post-prandial gastroesophageal reflux events are common following SG. We have defined the expected values of standardized esophageal transit and gastric emptying scintigraphy specifically tailored to SG patients.

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Acknowledgements

We would like to thank Dr Martin Cherk, Mr James Crocker, Dr Thomas Barber, Dr David Nadebaum, and Dr Jarrel Seah for their contribution to this study.

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Authors and Affiliations

  1. Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia

    Yazmin Johari, Cheryl Laurie, Wendy Brown & Paul Burton

  2. Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, VIC, 3004, Australia

    Yazmin Johari, Wendy Brown & Paul Burton

  3. Department of Nuclear Medicine & PET, The Alfred Hospital, Melbourne, VIC, 3004, Australia

    Helen Yue, Paul Beech & Kenneth Sk Yap

  4. Department of Gastroenterology, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, 3050, Australia

    Geoffrey Hebbard

  5. Department of Medicine, Monash University, Alfred Hospital Campus, Melbourne, VIC, 3004, Australia

    Kenneth Sk Yap

Authors
  1. Yazmin Johari
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  2. Helen Yue
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  3. Cheryl Laurie
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  4. Geoffrey Hebbard
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  7. Wendy Brown
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  8. Paul Burton
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Contributions

Yazmin Johari was extensively involved in design, data collection, data analysis, presentation, and write up. Helen Yue and Cheryl Laurie were involved in patient recruitment, data collection, and data representation. Geoffrey Hebbard, Paul Beech, Kenneth SK Yap, Wendy Brown, and Paul Burton were extensively involved in initial concept, design, supervision, data analysis, presentation, write up, and final approval of the paper.

Corresponding author

Correspondence to Yazmin Johari.

Ethics declarations

Ethical and Consent Statements

Ethics approval was obtained from our hospital Human Research and Ethics Committee (HREC) no. 380/16.

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.

An information statement was provided prior to commencement. Written informed consent was obtained from all individual participants included in the study.

Conflict of Interest

Yazmin Johari: No conflict of interest to declare. Helen Yue: No conflict of interest to declare. Cheryl Laurie: No conflict of interest to declare. Geoffrey Hebbard: No conflict of interest to declare. Paul Beech: No conflict of interest to declare. Kenneth SK Yap: No conflict of interest to declare. Wendy Brown: received grants from Johnson and Johnson, grants from Medtronic, grants from GORE, personal fees from GORE, grants from Applied Medical, grants from Apollo Endosurgery, grants and personal fees from Novo Nordisc, personal fees from Merck Sharpe and Dohme, outside the submitted work. Paul Burton: No conflict of interest to declare.

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Key Points

1. A 90-min gastric emptying study with semi-solids is easily reproducible.

2. The expected gastric emptying half-time is less than 30 min.

3. The initial proportion of small bowel substrate — less than 9% is abnormal.

4. Asymptomatic deglutitive and post-prandial reflux is ubiquitous post-SG.

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Johari, Y., Yue, H., Laurie, C. et al. Expected Values of Esophageal Transit and Gastric Emptying Scintigraphy Post-uncomplicated Sleeve Gastrectomy. OBES SURG 31, 3727–3737 (2021). https://doi.org/10.1007/s11695-021-05487-7

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