Mechanisms of Esophageal and Gastric Transit Following Sleeve Gastrectomy

Johari, Yazmin; Wickremasinghe, Anagi; Kiswandono, Pradipta; Yue, Helen; Ooi, Geraldine; Laurie, Cheryl; Hebbard, Geoffrey; Beech, Paul; Yap, Kenneth; Brown, Wendy A.; Burton, Paul R.

doi:10.1007/s11695-020-04988-1

Cited by 24 publications

(18 citation statements)

References 26 publications

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“…Swallowing is characterised by the filling of the proximal compartment, subsequent pressurisation, and emptying into the distal compartment. We surmised that previously reported intragastric hyper-pressurisations were related to this distention of the proximal compartment as this has been noted during concurrent fluoroscopy and intraluminal pressure measurements [ 9 ]. Measurement of Intraluminal Pressure in the Fasting State (Prolonged Study) In order to establish the range of intragastric pressurisation, we assessed the high-resolution manometry (HRM) of fourteen patients after sleeve gastrectomy and compared then to ten obese controls.…”

Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 91%

“…Data were recorded in real time using TRACE!1.2 (written by G. Hebbard using LabVIEW, National Instruments, Austin, TX). Our technique has been previously described [ 9 ]. We used a standardised protocol for each patient: (1) supine basal recording for 60 s, (2) 5 deep breaths, (3) 10 swallows with 5 ml water, (4) volume stress test (5 swallows of 10 ml water).…”

Section: Methodsmentioning

confidence: 99%

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Mechanism of Staple Line Leak After Sleeve Gastrectomy via Isobaric Pressurisation Concentrating Stress Forces at the Proximal Staple Line

et al. 2022

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Purpose Staple line leak following sleeve gastrectomy is a significant problem and has been hypothesised to be related to hyperpressurisation in the proximal stomach. There is, however, little objective evidence demonstrating how these forces could be transmitted to the luminal wall. We aimed to define conditions in the proximal stomach and simulate the transmission of stress forces in the post-operative stomach using a finite element analysis (FEA). Materials and Methods The manometry of fourteen patients post sleeve gastrectomy was compared to ten controls. Manometry, boundary conditions, and volumetric CT were integrated to develop six models. These models delineated luminal wall stress in the proximal stomach. Key features were then varied to establish the influence of each factor. Results The sleeve gastrectomy cohort had a significantly higher peak intragastric isobaric pressures 31.58 ± 2.1 vs. 13.49 ± 1.3 mmHg (p = 0.0002). Regions of stress were clustered at the staple line near the GOJ, and peak stress was observed there in 67% of models. A uniform greater curvature did not fail or concentrate stress under maximal pressurisation. Geometric variation demonstrated that a larger triangulated apex increased stress by 17% (255 kPa versus 218 kPa), with a 37% increase at the GOJ (203kPA versus 148kPA). A wider incisura reduced stress at the GOJ by 9.9% (128 kPa versus 142 kPa). Conclusion High pressure events can occur in the proximal stomach after sleeve gastrectomy. Simulations suggest that these events preferentially concentrate stress forces near the GOJ. This study simulates how high-pressure events could translate stress to the luminal wall and precipitate leak. Graphical Abstract

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 91%

Section: Methodsmentioning

confidence: 99%

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Mechanism of Staple Line Leak After Sleeve Gastrectomy via Isobaric Pressurisation Concentrating Stress Forces at the Proximal Staple Line

et al. 2022

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“…However, studies examining these changes are limited and controversial. Following VSG, accelerated gastric emptying has been reported using gastric scintigraphy [ 25 , 26 ], or magnetic resonance imaging [ 27 ]. Further, it has been shown, using electrical mapping, aberrant ectopic pacemaking and electrical quiescence leading to chronic dysmotility after VSG surgery [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

Changes in interstitial cells and gastric excitability in a mouse model of sleeve gastrectomy

et al. 2022

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Obesity is a critical risk factor of several life-threatening diseases and the prevalence in adults has dramatically increased over the past ten years. In the USA the age-adjusted prevalence of obesity in adults was 42.4%, i.e., with a body mass index (BMI, weight (kg)/height (m)2) that exceeds 30 kg/m2. Obese individuals are at the higher risk of obesity-related diseases, co-morbid conditions, lower quality of life, and increased mortality more than those in the normal BMI range i.e., 18.5–24.9 kg/m2. Surgical treatment continues to be the most efficient and scientifically successful treatment for obese patients. Sleeve gastrectomy or vertical sleeve gastrectomy (VSG) is a relatively new gastric procedure to reduce body weight but is now the most popular bariatric operation. To date there have been few studies examining the changes in the cellular components and pacemaker activity that occur in the gastric wall following VSG and whether normal gastric activity recovers following VSG. In the present study we used a murine model to investigate the chronological changes of gastric excitability including electrophysiological, molecular and morphological changes in the gastric musculature following VSG. There is a significant disruption in specialized interstitial cells of Cajal in the gastric antrum following sleeve gastrectomy. This is associated with a loss of gastric pacemaker activity and post-junctional neuroeffector responses. Over a 4-month recovery period there was a gradual return in interstitial cells of Cajal networks, pacemaker activity and neural responses. These data describe for the first time the changes in gastric interstitial cells of Cajal networks, pacemaker activity and neuroeffector responses and the time-dependent recovery of ICC networks and normalization of motor activity and neural responses following VSG.

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“…Several studies have noted an incidence between 6% and 47% (11)(12)(13)(14)(15). This has prompted discussion among the surgical community with regard to the underlying pathomechanisms of GERD after SG and the postoperative management of reflux disease (16)(17)(18)(19). So far, a number of new techniques have been reported to yield more encouraging results with regard to reflux symptoms after SG, but most evidence originates from retrospective studies with a small number of cases or is based on experts' opinions.…”

Section: Introductionmentioning

confidence: 99%

Current status of gastroesophageal reflux disease after sleeve gastrectomy: Still a long way to go

Tian

Yang

et al. 2021

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Mechanisms of Esophageal and Gastric Transit Following Sleeve Gastrectomy

Cited by 24 publications

References 26 publications

Mechanism of Staple Line Leak After Sleeve Gastrectomy via Isobaric Pressurisation Concentrating Stress Forces at the Proximal Staple Line

Mechanism of Staple Line Leak After Sleeve Gastrectomy via Isobaric Pressurisation Concentrating Stress Forces at the Proximal Staple Line

Changes in interstitial cells and gastric excitability in a mouse model of sleeve gastrectomy

Current status of gastroesophageal reflux disease after sleeve gastrectomy: Still a long way to go

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