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Obesity Surgery

, Volume 29, Issue 2, pp 569–578 | Cite as

A Higher Preoperative Glycemic Profile Is Associated with Rapid Gastric Emptying After Sleeve Gastrectomy for Obese Subjects

  • Po-Jen Yang
  • Mei-Fang Cheng
  • Wei-Shiung Yang
  • Ming-Shian Tsai
  • Po-Chu Lee
  • Chiung-Nien Chen
  • Ming-Tsan Lin
  • Ping-Huei TsengEmail author
Original Contributions
  • 58 Downloads

Abstract

Background

Recent reports have shown that sleeve gastrectomy (SG) accelerates gastric emptying (GE), but the etiology remains unclear. This study aimed to investigate the factors affecting GE before and after SG.

Methods

We enrolled 35 normal weight healthy subjects and 23 obese patients receiving SG. The normal individuals and obese patients before and 3 months after SG received oatmeal-based scintigraphy to measure GE. Gastrointestinal symptoms and circulating levels of peptide YY (PYY) were also measured.

Results

There were no differences in the GE parameters, including simple half-time at 3 h and percentage of gastric retention at 0.5, 1, 2, and 3 h between healthy controls and pre-SG obese subjects. SG led to accelerated GE, more gastrointestinal symptoms, and increased fasting PYY levels postoperatively. Based on our previously established normal GE values, 18 (78.3%) obese patients with rapid postoperative GE had higher levels of preoperative fasting glucose and glycated hemoglobin, and homeostasis model assessment of the insulin resistance index than those with normal postoperative GE. Twelve (52.2%) obese patients had preoperative diabetes mellitus (DM), and only four (17.4%) remained diabetic after SG. The post-SG gastric retention at 0.5 and 1 h was lower in patients with preoperative DM than in those without preoperative DM. Neither severity of gastrointestinal symptoms nor fasting PYY levels were associated with postoperative GE alterations.

Conclusion

Most of the obese patients had accelerated GE after SG. A higher preoperative glycemic profile was associated with rapid post-SG GE.

Keywords

Gastric emptying Sleeve gastrectomy Diabetes Obesity 

Notes

Funding

This project was supported in part by grants from the National Taiwan University Hospital (NTUH 105-M3266 and NTUH 107-S3776) and E-Da Hospital – National Taiwan University Hospital Joint Research Program (NTUH 106-EDN19).

Compliance with Ethical Standards

Conflict of Interest

All the contributing authors declare that they have no conflicts of interest.

Ethical Approval

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.

References

  1. 1.
    Gagner M. The future of sleeve gastrectomy. Eur Endocrinol. 2016;12(1):37–8.Google Scholar
  2. 2.
    Shoar S, Saber AA. Long-term and midterm outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of comparative studies. Surg Obes Relat Dis. 2017;13(2):170–80.Google Scholar
  3. 3.
    El Labban S, Safadi B, Olabi A. The effect of Roux-en-Y gastric bypass and sleeve gastrectomy surgery on dietary intake, food preferences, and gastrointestinal symptoms in post-surgical morbidly obese Lebanese subjects: a cross-sectional pilot study. Obes Surg. 2015;25(12):2393–9.Google Scholar
  4. 4.
    Andersen JR. Quality of life following laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2015;11(1):76–8.Google Scholar
  5. 5.
    Vidal J, Ibarzabal A, Nicolau J, et al. Short-term effects of sleeve gastrectomy on type 2 diabetes mellitus in severely obese subjects. Obes Surg. 2007;17(8):1069–74.Google Scholar
  6. 6.
    Rizzello M, Abbatini F, Casella G, et al. Early postoperative insulin-resistance changes after sleeve gastrectomy. Obes Surg. 2010;20(1):50–5.Google Scholar
  7. 7.
    Mingrone G, Castagneto-Gissey L. Mechanisms of early improvement/resolution of type 2 diabetes after bariatric surgery. Diabetes Metab. 2009;35(6 Pt 2):518–23.Google Scholar
  8. 8.
    Braghetto I, Davanzo C, Korn O, et al. Scintigraphic evaluation of gastric emptying in obese patients submitted to sleeve gastrectomy compared to normal subjects. Obes Surg. 2009;19(11):1515–21.Google Scholar
  9. 9.
    Shah S, Shah P, Todkar J, et al. Prospective controlled study of effect of laparoscopic sleeve gastrectomy on small bowel transit time and gastric emptying half-time in morbidly obese patients with type 2 diabetes mellitus. Surg Obes Relat Dis. 2010;6(2):152–7.Google Scholar
  10. 10.
    Sioka E, Tzovaras G, Perivoliotis K, et al. Impact of laparoscopic sleeve gastrectomy on gastrointestinal motility. Gastroenterol Res Pract. 2018;2018:4135813.Google Scholar
  11. 11.
    Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401–7.Google Scholar
  12. 12.
    Sista F, Abruzzese V, Clementi M, et al. The effect of sleeve gastrectomy on GLP-1 secretion and gastric emptying: a prospective study. Surg Obes Relat Dis. 2017;13(1):7–14.Google Scholar
  13. 13.
    Vigneshwaran B, Wahal A, Aggarwal S, et al. Impact of sleeve gastrectomy on type 2 diabetes mellitus, gastric emptying time, glucagon-like peptide 1 (GLP-1), ghrelin and leptin in non-morbidly obese subjects with BMI 30-35.0 kg/m(2): a prospective study. Obes Surg. 2016;26(12):2817–23.Google Scholar
  14. 14.
    Pomerri F, Foletto M, Allegro G, et al. Laparoscopic sleeve gastrectomy–radiological assessment of fundus size and sleeve voiding. Obes Surg. 2011;21(7):858–63.Google Scholar
  15. 15.
    Bernstine H, Tzioni-Yehoshua R, Groshar D, et al. Gastric emptying is not affected by sleeve gastrectomy–scintigraphic evaluation of gastric emptying after sleeve gastrectomy without removal of the gastric antrum. Obes Surg. 2009;19(3):293–8.Google Scholar
  16. 16.
    American Diabetes A.2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S13–27.Google Scholar
  17. 17.
    Tseng PH, Wu YW, Lee YC, et al. Normal values and symptom correlation of a simplified oatmeal-based gastric emptying study in the Chinese population. J Gastroenterol Hepatol. 2014;29(11):1873–82.Google Scholar
  18. 18.
    Revicki DA, Rentz AM, Dubois D, et al. Gastroparesis cardinal symptom index (GCSI): development and validation of a patient reported assessment of severity of gastroparesis symptoms. Qual Life Res. 2004;13(4):833–44.Google Scholar
  19. 19.
    Xing J, Chen JD. Alterations of gastrointestinal motility in obesity. Obes Res. 2004;12(11):1723–32.Google Scholar
  20. 20.
    Acosta A, Camilleri M, Shin A, et al. Quantitative gastrointestinal and psychological traits associated with obesity and response to weight-loss therapy. Gastroenterology. 2015;148(3):537–46 e4.Google Scholar
  21. 21.
    Vazquez Roque MI, Camilleri M, Stephens DA, et al. Gastric sensorimotor functions and hormone profile in normal weight, overweight, and obese people. Gastroenterology. 2006;131(6):1717–24.Google Scholar
  22. 22.
    Seimon RV, Brennan IM, Russo A, et al. Gastric emptying, mouth-to-cecum transit, and glycemic, insulin, incretin, and energy intake responses to a mixed-nutrient liquid in lean, overweight, and obese males. Am J Physiol Endocrinol Metab. 2013;304(3):E294–300.Google Scholar
  23. 23.
    Buchholz V, Berkenstadt H, Goitein D, et al. Gastric emptying is not prolonged in obese patients. Surg Obes Relat Dis. 2013;9(5):714–7.Google Scholar
  24. 24.
    Melissas J, Leventi A, Klinaki I, et al. Alterations of global gastrointestinal motility after sleeve gastrectomy: a prospective study. Ann Surg. 2013;258(6):976–82.Google Scholar
  25. 25.
    Baumann T, Kuesters S, Grueneberger J, et al. Time-resolved MRI after ingestion of liquids reveals motility changes after laparoscopic sleeve gastrectomy–preliminary results. Obes Surg. 2011;21(1):95–101.Google Scholar
  26. 26.
    Hinder RA, Kelly KA. Human gastric pacesetter potential. Site of origin, spread, and response to gastric transection and proximal gastric vagotomy. Am J Surg. 1977;133(1):29–33.Google Scholar
  27. 27.
    O'Grady G, Du P, Cheng LK, et al. Origin and propagation of human gastric slow-wave activity defined by high-resolution mapping. Am J Physiol Gastrointest Liver Physiol. 2010;299(3):G585–92.Google Scholar
  28. 28.
    Berry R, Cheng LK, Du P, et al. Patterns of abnormal gastric pacemaking after sleeve gastrectomy defined by laparoscopic high-resolution electrical mapping. Obes Surg. 2017;27(8):1929–37.Google Scholar
  29. 29.
    Vives M, Molina A, Danus M, et al. Analysis of gastric physiology after laparoscopic sleeve gastrectomy (LSG) with or without antral preservation in relation to metabolic response: a randomised study. Obes Surg. 2017;27(11):2836–44.Google Scholar
  30. 30.
    Phillips LK, Rayner CK, Jones KL, et al. Measurement of gastric emptying in diabetes. J Diabetes Complicat. 2014;28(6):894–903.Google Scholar
  31. 31.
    Chang J, Rayner CK, Jones KL, et al. Diabetic gastroparesis and its impact on glycemia. Endocrinol Metab Clin N Am. 2010;39(4):745–62.Google Scholar
  32. 32.
    Marathe CS, Rayner CK, Jones KL, et al. Relationships between gastric emptying, postprandial glycemia, and incretin hormones. Diabetes Care. 2013;36(5):1396–405.Google Scholar
  33. 33.
    Ariga H, Imai K, Chen C, et al. Does ghrelin explain accelerated gastric emptying in the early stages of diabetes mellitus? Am J Phys Regul Integr Comp Phys. 2008;294(6):R1807–12.Google Scholar
  34. 34.
    Vilsboll T, Krarup T, Deacon CF, et al. Reduced postprandial concentrations of intact biologically active glucagon-like peptide 1 in type 2 diabetic patients. Diabetes. 2001;50(3):609–13.Google Scholar
  35. 35.
    Falken Y, Hellstrom PM, Sanger GJ, et al. Actions of prolonged ghrelin infusion on gastrointestinal transit and glucose homeostasis in humans. Neurogastroenterol Motil. 2010;22(6):e192–200.Google Scholar
  36. 36.
    Halim MA, Degerblad M, Sundbom M, et al. Glucagon-like peptide-1 inhibits prandial gastrointestinal motility through myenteric neuronal mechanisms in humans. J Clin Endocrinol Metab. 2018;103(2):575–85.Google Scholar
  37. 37.
    Kiely JM, Noh JH, Graewin SJ, et al. Altered intestinal motility in leptin-deficient obese mice. J Surg Res. 2005;124(1):98–103.Google Scholar
  38. 38.
    Savage AP, Adrian TE, Carolan G, et al. Effects of peptide YY (PYY) on mouth to caecum intestinal transit time and on the rate of gastric emptying in healthy volunteers. Gut. 1987;28(2):166–70.Google Scholar
  39. 39.
    Witte AB, Gryback P, Holst JJ, et al. Differential effect of PYY1-36 and PYY3-36 on gastric emptying in man. Regul Pept. 2009;158(1–3):57–62.Google Scholar
  40. 40.
    Ballsmider LA, Vaughn AC, David M, et al. Sleeve gastrectomy and Roux-en-Y gastric bypass alter the gut-brain communication. Neural Plast. 2015;2015:601985.Google Scholar
  41. 41.
    Liu L, Ji G, Li G, et al. Structural changes in brain regions involved in executive-control and self-referential processing after sleeve gastrectomy in obese patients. Brain Imaging Behav. 2018;  https://doi.org/10.1007/s11682-018-9904-2.
  42. 42.
    Batterham RL, Cohen MA, Ellis SM, et al. Inhibition of food intake in obese subjects by peptide YY3-36. N Engl J Med. 2003;349(10):941–8.Google Scholar
  43. 43.
    Dimitriadis E, Daskalakis M, Kampa M, et al. Alterations in gut hormones after laparoscopic sleeve gastrectomy: a prospective clinical and laboratory investigational study. Ann Surg. 2013;257(4):647–54.Google Scholar
  44. 44.
    Cahill F, Ji Y, Wadden D, et al. The association of serum total peptide YY (PYY) with obesity and body fat measures in the CODING study. PLoS One. 2014;9(4):e95235.Google Scholar
  45. 45.
    Burgerhart JS, van Rutte PW, Edelbroek MA, et al. Association between postprandial symptoms and gastric emptying after sleeve gastrectomy. Obes Surg. 2015;25(2):209–14.Google Scholar
  46. 46.
    Farre R, Vanheel H, Vanuytsel T, et al. In functional dyspepsia, hypersensitivity to postprandial distention correlates with meal-related symptom severity. Gastroenterology. 2013;145(3):566–73.Google Scholar
  47. 47.
    Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy–volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.Google Scholar
  48. 48.
    Mion F, Tolone S, Garros A, et al. High-resolution impedance manometry after sleeve gastrectomy: increased intragastric pressure and reflux are frequent events. Obes Surg. 2016;26(10):2449–56.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Po-Jen Yang
    • 1
    • 2
  • Mei-Fang Cheng
    • 3
  • Wei-Shiung Yang
    • 2
    • 4
    • 5
  • Ming-Shian Tsai
    • 6
    • 7
  • Po-Chu Lee
    • 1
    • 2
  • Chiung-Nien Chen
    • 1
    • 2
  • Ming-Tsan Lin
    • 1
  • Ping-Huei Tseng
    • 2
    • 5
    Email author
  1. 1.Department of SurgeryNational Taiwan University HospitalTaipeiTaiwan
  2. 2.Center for Obesity, Life Style, and Metabolic SurgeryNational Taiwan University HospitalTaipeiTaiwan
  3. 3.Department of Nuclear MedicineNational Taiwan University HospitalTaipeiTaiwan
  4. 4.Graduate Institute of Clinical Medicine, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  5. 5.Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
  6. 6.Department of SurgeryE-Da HospitalKaohsiungTaiwan
  7. 7.School of MedicineI-Shou UniversityKaohsiungTaiwan

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