Patterns of Abnormal Gastric Pacemaking After Sleeve Gastrectomy Defined by Laparoscopic High-Resolution Electrical Mapping

Berry, Rachel; Cheng, Leo K.; Du, Peng; Paskaranandavadivel, Niranchan; Angeli, Timothy R.; Mayne, Terence; Beban, Grant; O’Grady, Gregory

doi:10.1007/s11695-017-2597-6

Cited by 57 publications

(46 citation statements)

References 40 publications

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“…Eighteen studies assessed stomach motility. Eleven studies were conducted in Europe (Spain [ n = 2] [ 14 , 15 ], Italy [ n = 3] [ 16 – 18 ], Greece [ n = 3] [ 19 – 21 ], Czech Republic [ n = 1] [ 22 ], Germany [ n = 1] [ 23 ], and the Netherlands [ n = 1] [ 24 ]), whereas one study was performed in the USA [ 25 ], two studies in India [ 26 , 27 ], one study in New Zealand [ 28 ], one in Egypt [ 29 ], one in Chile [ 30 ], and one in Israel [ 31 ]. Twelve studies were prospective studies, four studies were prospective randomized controlled studies [ 14 , 17 , 22 , 27 ], and two were retrospective studies [ 18 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

Impact of Laparoscopic Sleeve Gastrectomy on Gastrointestinal Motility

Sioka

Tzovaras

Perivoliotis

et al. 2018

Gastroenterology Research and Practice

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Objective Laparoscopic sleeve gastrectomy (LSG) was considered mainly as a restrictive procedure due to anatomic alterations in the upper gastrointestinal tract. Additionally, due to neurohormonal alterations, LSG modifies the gastrointestinal motility, which controls appetite and feeling of satiety. Aim The aim of the study was to review the impact of laparoscopic sleeve gastrectomy on gastrointestinal motility. Material and Methods A search of the medical literature was undertaken in Pubmed, Web of Science, and Cochrane library. Esophageal, gastric, bowel motility were assessed separately. Results Nine studies assessed esophageal motility. The data remain debatable attributing to the heterogeneity of follow-up timing, surgical technique, bougie size, and distance from pylorus. The stomach motility was assessed in eighteen studies. Functionally, the sleeve was divided into a passive sleeve and an accelerated antrum. All scintigraphic studies revealed accelerated gastric emptying after LSG except of one. Patients demonstrated a rapid gastroduodenal transit time. The resection of the gastric pacemaker had as a consequence aberrant distal ectopic pacemaking or bioelectrical quiescence after LSG. The bowel motility was the least studied. Small bowel transit time was reduced; opposite to that the initiation of cecal filling and the ileocecal valve transit was delayed. Conclusion Laparoscopic sleeve gastrectomy has impacts on gastrointestinal motility. The data remain debatable for esophageal motility. Stomach and small bowel motility were accelerated, while the initiation of cecal filling and the ileocecal valve transit was delayed. Further pathophysiological studies are needed to evaluate the correlation of motility data with clinical symptoms.

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Section: Resultsmentioning

confidence: 99%

Impact of Laparoscopic Sleeve Gastrectomy on Gastrointestinal Motility

Sioka

Tzovaras

Perivoliotis

et al. 2018

Gastroenterology Research and Practice

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“…This may result from the reduction in volume of the gastric reservoir which is specific to the proximal stomach which may lead to increased intragastric pressure after meals, resulting in accelerated passage of nutriments to the small bowel . On the other hand, the resection of the gastric pacemaker zone during sleeve gastrectomy can result in aberrant distal ectopic pacemaking or bioelectrical quiescence according to results from a recent study . However, the clinical relevance of this postoperative gastric dysrhythmia requires further investigations.…”

Section: Discussionmentioning

confidence: 99%

Pyloric distensibility measurement after gastric surgery: Which surgeries are associated with pylorospasm?

Desprez

Melchior

Wuestenberghs

et al. 2020

Neurogastroenterology Motil

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Background and study aims: History of gastric surgery is found in 10% of patients with gastroparesis, and vagal lesion is often suspected to be the cause of pylorospasm. Recently, pyloric distensibility measurement using the EndoFLIP ® system showed that pylorospasm was present in 30%-50% of gastroparetic patients. Our objective was to assess whether pylorospasm, diagnosed using EndoFLIP ® system was observed in three different types of gastric surgeries: antireflux surgery, sleeve gastrectomy, and esophagectomy. Patients and Methods:Pyloric distensibility and pressure were measured using the EndoFLIP ® system in 43 patients from two centers (18 antireflux surgery, 16 sleeve gastrectomy, and nine esophagectomy) with dyspeptic symptoms after gastric surgery, and in 21 healthy volunteers. Altered pyloric distensibility was defined as distensibility below 10 mm 2 /mm Hg as previously reported.Results: Compared to healthy volunteers (distensibility: 25.2 ± 2.4 mm 2 /mm Hg; pressure: 9.7 ± 4.4 mm Hg), pyloric distensibility was decreased in 61.1% of patients in the antireflux surgery group (14.5 ± 3.4 mm 2 /mm Hg; P < .01) and 75.0% of patients in the esophagectomy group (10.8 ± 2.1 mm 2 /mm Hg; P < .05), while pyloric pressure was only increased in the antireflux surgery group (18.9 ± 2.2 mm Hg; P < .01). Pyloric distensibility and pressure were similar in healthy volunteers and in sleeve gastrectomy (distensibility: 20.3 ± 3.8 mm 2 /mm Hg; pressure: 15.8 ± 1.6 mm Hg) groups, with decreased pyloric distensibility affecting 18.7% of sleeve gastrectomy patients. Conclusion:Antireflux surgery and esophagectomy were associated with pylorospasm although pylorospasm was not found in all patients. Sleeve gastrectomy was not associated with altered pyloric distensibility nor altered pyloric pressure.

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“…The methods developed in this study can now be further usefully applied and expanded to investigate slow wave characteristics in the human intestine in more detail, for example, by expanding to other regions of the intestine to quantitate velocity and pacemaking gradients along the intestinal length, investigate the spatiotemporal occurrence and significance of “waxing and waning,” and expand to states of disease and/or surgical intervention, as has been usefully achieved in the stomach . The use of minimally invasive approaches in future studies, like laparoscopic or endoscopic mapping, would enable greater patient recruitment and minimize intestinal handling and exposure, which may help to clarify the issue of the occurrence and cause of disordered propagation. Non‐invasive approaches for recording small intestine slow wave activity, including electroenterography and magnetoenterography, also hold promise and could be better informed by the spatial analysis provided by HR mapping …”

Section: Discussionmentioning

confidence: 99%