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Effects of Laparoscopic Sleeve Gastrectomy on Gastric Structure and Function Documented by Magnetic Resonance Imaging Are Strongly Associated with Post-operative Weight Loss and Quality of Life: a Prospective Study

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Abstract

Background

This prospective study applied magnetic resonance imaging (MRI) to assess the effect of laparoscopic sleeve gastrectomy (LSG) on gastric structure and function. The impact of these changes on patient outcomes was analyzed.

Method

Obese patients without gastrointestinal symptoms referred for bariatric surgery were recruited prospectively. Pre-operative assessment included (i) high-resolution manometry and pH-impedance monitoring and (ii) magnetic resonance imaging (MRI) measurement of gastric capacity, accommodation, and emptying with the 400 ml liquid Nottingham test meal (NTM). Studies were repeated 6–7 months after LSG. Weight loss and changes in the Gastrointestinal Quality of Life Index (GIQLI) assessed patient outcomes.

Results

From 35 patients screened, 23 (66%) completed the study (17 females, age 36 ± 10 years, BMI 42 ± 5 kg/m2). Mean excess weight loss was 59 ± 18% at follow-up. Total gastric volume (capacity) after the meal was 467 mL (455–585 ml) before and 139 mL (121–185 ml) after LSG (normal reference 534 (419–675) mL), representing a mean 70% reduction (p < 0.0001). Similar findings were present for gastric content volume indicating rapid early-phase gastric emptying (GE) post-LSG. Conversely, late-phase GE was slower post-LSG (2.5 ± 1.0 vs. 1.4 ± 0.6 mL/min; p < 0.0001; (reference 1.5(1.4–4.9) mL/min)). Patients with ≥ 80% reduction in gastric capacity had greater weight loss (p = 0.008), but worse gastrointestinal outcomes (p = 0.023).

Conclusions

MRI studies quantified the marked reduction in gastric capacity after LSG. The reduction in capacity was associated with rapid early- but slow late-phase GE after surgery. These changes were associated with weight loss; however, reductions in gastric capacity ≥ 80% were linked to increased acid reflux and impacted on gastrointestinal quality of life.

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Notes

  1. The increase in TGV after a liquid test meal is often less than the volume ingested because the rate of early-phase GE is greater than the rate of secretion.

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Authors and Affiliations

  1. IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France

    Claudio Fiorillo, Giuseppe Quero & Silvana Perretta

  2. Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00166, Rome, Italy

    Claudio Fiorillo & Giuseppe Quero

  3. IRCAD, Research Institute against Digestive Cancer, Strasbourg, France

    Bernard Dallemagne & Silvana Perretta

  4. Department of Gastroenterology and Hepatology, University Hospital Zürich, CH-8091, Zürich, Switzerland

    Jelena Curcic & Mark Fox

  5. Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Digestive Diseases, Center for Integrative Gastroenterology, Klinik Arlesheim, CH-4144, Arlesheim, Switzerland

    Mark Fox

  6. Department of General, Digestive and Endocrine Surgery, University of Strasbourg, Strasbourg, France

    Silvana Perretta

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  1. Claudio Fiorillo
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Correspondence to Giuseppe Quero.

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

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Fiorillo, C., Quero, G., Dallemagne, B. et al. Effects of Laparoscopic Sleeve Gastrectomy on Gastric Structure and Function Documented by Magnetic Resonance Imaging Are Strongly Associated with Post-operative Weight Loss and Quality of Life: a Prospective Study. OBES SURG 30, 4741–4750 (2020). https://doi.org/10.1007/s11695-020-04831-7

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  • DOI: https://doi.org/10.1007/s11695-020-04831-7

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