Association Between Postprandial Symptoms and ... - Springer Link

2 downloads 0 Views 259KB Size Report
Sep 13, 2014 - Abstract. Background Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure. However, postprandial symp- toms can ...
OBES SURG (2015) 25:209–214 DOI 10.1007/s11695-014-1410-z

ORIGINAL CONTRIBUTIONS

Association Between Postprandial Symptoms and Gastric Emptying After Sleeve Gastrectomy Jan S. Burgerhart & Pim W. J. van Rutte & Michela A. L. Edelbroek & Dirk N. J. Wyndaele & Johannes F. Smulders & Paul C. van de Meeberg & Peter D. Siersema & André J. P. M. Smout

Published online: 13 September 2014 # Springer Science+Business Media New York 2014

Abstract Background Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure. However, postprandial symptoms can compromise its beneficial effect. It is not known if a changed gastric emptying and these symptoms are related. This study aimed to assess the association between postprandial symptoms and the gastric emptying pattern after LSG. Methods A gastric emptying study with a solid and liquid meal component was performed in the second year after LSG. Before the test, symptoms were assessed using a standardized questionnaire, and during the test, symptoms were scored on a visual analog scale (VAS). Gastric emptying results were expressed as lag phase, half time of gastric emptying (T½), and caloric emptying rate/minute. Results Twenty patients (14 F/6 M; age 45.6±7.7 years, weight 93.4±28.2 kg, BMI 31.6±8.1 kg/m2) participated in this study; 13 had a low symptom score (≤9, group I), 7 a high

symptom score (≥18, group II). VAS scores for epigastric pain, nausea, and belching were significantly higher in group II. Lag phase (solid) was 6.4±4.5 min in group I, 7.3±6.3 in group II (p=0.94); T½ (solid) was 40.6±10.0 min in group I, 34.4±9.3 in group II (p=0.27); caloric emptying rate was 3.9 ±0.6 kcal/min in group I, 3.9±1.0 kcal/min in group II (p= 0.32). Conclusions Patients with postprandial symptoms after LSG reported more symptoms during the gastric emptying study than patients without symptoms. However, there was no difference between gastric emptying characteristics between both groups, suggesting that abnormal gastric emptying is not a major determinant of postprandial symptoms after LSG.

J. S. Burgerhart : P. D. Siersema Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands

M. A. L. Edelbroek : D. N. J. Wyndaele Department of Nuclear Medicine, Catharina Hospital, Eindhoven, The Netherlands

P. D. Siersema e-mail: [email protected] J. S. Burgerhart (*) : P. C. van de Meeberg Dutch Obesity Clinic, Hilversum, The Netherlands e-mail: [email protected] P. C. van de Meeberg e-mail: [email protected] P. W. J. van Rutte : J. F. Smulders Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands P. W. J. van Rutte e-mail: [email protected] J. F. Smulders e-mail: [email protected]

Keywords Sleeve gastrectomy . Postprandial symptoms . Gastric emptying

M. A. L. Edelbroek e-mail: [email protected] D. N. J. Wyndaele e-mail: [email protected]

P. C. van de Meeberg Department of Gastroenterology and Hepatology, Slingeland Hospital Doetinchem, Doetinchem, The Netherlands

A. J. P. M. Smout Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands e-mail: [email protected]

210

Introduction Sleeve gastrectomy as a stand-alone procedure is a relatively new but promising bariatric surgical procedure to treat morbidly obese patients [1]. During this surgical intervention, the greater curvature of the stomach is resected along a gastric tube, in order to reduce the gastric volume to 75–120 mL. Gastrointestinal transit is involved in the regulation of food intake through multiple neurohormonal pathways with feedback on the muscular gastrointestinal compartment [2]. Sleeve gastrectomy affects gastric motility, and several radionuclide studies have demonstrated accelerated gastric emptying for liquids as well as solids [3–5]. Accelerated gastric emptying seems to be caused by a loss of receptive and adaptive relaxation of the fundic tone and faster peristaltic contractions [6]. Accelerated gastric emptying after sleeve gastrectomy may also enhance satiety signals and reduce intake. In this way, weight loss and improvement in glucose metabolism after sleeve gastrectomy are amplified [3]. However, in a considerable proportion of postoperative laparoscopic sleeve gastrectomy (LSG) patients, postprandial symptoms compromise the beneficial effect of the procedure [7, 8]. The mechanisms involved in the generation of these postprandial symptoms have hardly been studied. Keidar et al. concluded from their study on a large series of sleeve gastrectomy patients that the changed anatomy plays a role in postoperative symptoms, with a dilated upper sleeve being associated with gastroesophageal dysmotility and reflux symptoms [9]. The current study aimed to assess the association between postprandial symptoms and gastric emptying of a mixed solid and liquid meal at least 12 months after sleeve gastrectomy. We hypothesized that gastric emptying of solids and liquids is more disturbed in the group with postprandial symptoms than in patients without these symptoms.

Methods Twenty morbidly obese patients (BMI >40 or >35 kg m2 with obesity-related comorbidity) participated in this study. They underwent a sleeve gastrectomy between July 2011 and February 2012 in the Catharina Hospital, Eindhoven, The Netherlands. The ethics committee of the hospital approved this research. Informed consent was obtained from all individual participants included in the study. Surgical Technique During a laparoscopic procedure, a tubular gastric pouch of 75–120 mL was created by resecting the greater curvature of the stomach along a 34-French bougie that was inserted along the lesser curvature. The pouch was created using a stapler (Endo GIA Tri-Stapler, Covidien, Dublin, Ireland) starting about 6 cm proximal to the pylorus

OBES SURG (2015) 25:209–214

and continuing parallel to the lesser curvature of the stomach to the angle of His, ending approximately 1 cm to the left of the esophagus [10]. Questionnaires Assessment of postprandial symptoms before the gastric emptying study was performed at least 12 months after the LSG, using a questionnaire with six items concerning fullness, early satiety, reflux or regurgitation, and epigastric discomfort/pain (with a “0” (no symptoms) to “6” (daily symptoms) scale, maximum score 36). Based on this questionnaire, the study population was divided into two groups, one with a low postprandial symptom score (≤9) and one with a high score (≥18). Such categorization was felt to be justified because no patient had a score between 10 and 17 (see “Results”). During the gastric emptying study, the symptoms fullness, epigastric pain, belching, nausea, and heartburn were assessed at 5, 10, 15, 30, and 60 min after completion of the meal, using a visual analog scale (VAS) from 0 to 10 (0, absence of symptoms; 10, unbearable symptoms). Gastric Emptying Study The patients were instructed to fast from midnight until the next morning. Their blood glucose levels were determined before they ate the test meal, which was repeated 90 min postprandially. Before the start of the study, the blood glucose level had to be