TY - JOUR
T1 - 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
AU - Fiorillo, Claudio
AU - Quero, Giuseppe
AU - Dallemagne, Bernard
AU - Curcic, Jelena
AU - Fox, Mark
AU - Perretta, Silvana
PY - 2020
Y1 - 2020
N2 - 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; (reference1.5(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.
AB - 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; (reference1.5(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.
KW - Gastric accommodation
KW - Gastric capacity
KW - Magnetic resonance imaging
KW - Laparoscopic sleeve gastrectomy
KW - Gastric emptying
KW - Gastric accommodation
KW - Gastric capacity
KW - Magnetic resonance imaging
KW - Laparoscopic sleeve gastrectomy
KW - Gastric emptying
UR - http://hdl.handle.net/10807/260350
U2 - 10.1007/s11695-020-04831-7
DO - 10.1007/s11695-020-04831-7
M3 - Article
SN - 0960-8923
VL - 30
SP - 4741
EP - 4750
JO - Obesity Surgery
JF - Obesity Surgery
ER -