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The Evaluation of Gastric Emptying Using Nuclear Scintigraphy Compared to Three-Dimensional Multi-detector Computed Tomography (3D-MDCT) Gastric Volumetry in the Assessment of Poor Weight Loss Following Sleeve Gastrectomy

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Abstract

Background

Poor weight loss and weight regain are principal challenges following laparoscopic sleeve gastrectomy (LSG). There is a lack of standardised assessments and diagnostic tests to stratify the status post-LSG and determine whether anatomical or physiological problem exists. We aimed to compare nuclear scintigraphy gastric emptying with CT volumetric analysis of sleeve anatomy and determine the impact of anatomy on physiological function and its correlation with weight loss.

Materials and Methods

Patients greater than 12 months post-LSG were categorised into optimal weight loss (OWL) (n = 29) and poor weight loss groups (PWL) (n = 50). All patients underwent a protocolised nuclear scintigraphy and three-dimensional multi-detector computed tomography (3D-MDCT) gastric volumetry imaging.

Results

Post-operative % total weight loss in OWL was 26.2 ± 10.5% vs. 14.2 ± 10.7% in the PWL group (p value < 0.0001). The PWL group had significantly more delayed gastric emptying half-time than OWL (34.1 ± 18.8 vs. 19.5 ± 4.7, p value < 0.0001). Gastric emptying half-time showed statistically significant correlations with weight loss parameters (BMI; r = 0.215, p value 0.048, %EWL; r =  − 0.336, p value 0.002 and %TWL; r =  − 0.379, p value < 0.001). The median gastric volume on 3D-MDCT did not differ between the OWL (246 (IQR 50) ml) and PWL group (262 (IQR 129.5) ml), p value 0.515. Nuclear scintigraphy gastric emptying half-time was the most highly discriminant measure. A threshold of 21.2 min distinguished OWL from PWL patients with 86.4% sensitivity and 68.4% specificity.

Conclusion

Nuclear scintigraphy is a potentially highly accurate tool in the functional assessment of sleeve gastrectomy physiology. It appears to perform better as a diagnostic test than volumetric assessment. Gastric volume did not correlate with weight loss outcomes. We have established diagnostic criteria of greater than 21 min to assess sleeve failure, which is linked to suboptimal weight loss outcomes.

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Authors and Affiliations

  1. Department of Surgery, Central Clinical School, Monash University, Monash University, Melbourne, Australia

    Anagi Wickremasinghe, Jessica Ferdinands, Yazmin Johari, Yit Leang, Cheryl Laurie, Wendy Brown & Paul Burton

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

    Yazmin Johari, Yit Leang, Wendy Brown & Paul Burton

  3. Department of Radiology, The Avenue Hospital, Melbourne, Australia

    Patrick Ho

  4. Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Australia

    Helen Yue, Paul Beech, David P. Nadebaum & Kenneth S. Yap

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

    Kenneth S. Yap

  6. Department of Gastroenterology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia

    Geoffrey Hebbard

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  1. Anagi Wickremasinghe
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  2. Jessica Ferdinands
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Corresponding author

Correspondence to Anagi Wickremasinghe.

Ethics declarations

Ethics Approval and Consent to Participate

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

Anagi Wickremasinghe was supported by an Australian Government Research Training Programme (RTP) Scholarship. Yit Leang was supported by an Australian Government Research Training Programme (RTP) Scholarship. Geoffrey Hebbard and Wendy Brown received Grants from Johnson and Johnson, Medtronic, GORE, Applied Medical, Novo Nordisk and the Australian Commonwealth Government and personal fees from GORE, Novo Nordisk, Pfizer and Merck Sharpe and Dohme for lectures and advisory boards. The other authors declare no competing interests.

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Key Points

• Gastric emptying half-time of greater than 21 minutes was closely associated with poor weight loss post-sleeve gastrectomy.

• Gastric emptying half-time correlated with post-operative weight loss parameters (BMI, %EWL and %TWL).

• Gastric volume did not discriminate optimal and suboptimal weight loss sleeve gastrectomy patients.

• Gastric volume did not correlate with weight loss.

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Wickremasinghe, A., Ferdinands, J., Johari, Y. et al. The Evaluation of Gastric Emptying Using Nuclear Scintigraphy Compared to Three-Dimensional Multi-detector Computed Tomography (3D-MDCT) Gastric Volumetry in the Assessment of Poor Weight Loss Following Sleeve Gastrectomy. OBES SURG 34, 150–162 (2024). https://doi.org/10.1007/s11695-023-06951-2

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  • DOI: https://doi.org/10.1007/s11695-023-06951-2

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