Radical Resection of the Pyloric Antrum and Its Effect on Gastric Emptying After Sleeve Gastrectomy

Michalský, David; Dvorák, P; Běláček, Jaromír; Kasalický, M

doi:10.1007/s11695-012-0850-6

Cited by 64 publications

(38 citation statements)

References 36 publications

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“…Similar gastric emptying rates were observed for MO and nonobese individuals but a highly accelerated rate for SG patients; this result agrees with some studies (8, 9, 29) but contradicts others (30,31), which suggested that antrum size after SG could influence gastric emptying. Some authors have hypothesized that higher intragastric pressure (32) with less peristalsis of the sleeve and faster propagation of antral propulsion waves (33) may play a role in this accelerated emptying.…”

Section: Discussionsupporting

confidence: 89%

Sleeve gastrectomy effects on hunger, satiation, and gastrointestinal hormone and motility responses after a liquid meal test

Mans¹,

Serra‐Prat

Palomera³

et al. 2015

The American Journal of Clinical Nutrition

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Background: The relation between hunger, satiation, and integrated gastrointestinal motility and hormonal responses in morbidly obese patients after sleeve gastrectomy has not been determined. Objective: The objective was to assess the effects of sleeve gastrectomy on hunger, satiation, gastric and gallbladder motility, and gastrointestinal hormone response after a liquid meal test. Design: Three groups were studied: morbidly obese patients (n = 16), morbidly obese patients who had had sleeve gastrectomy (n = 8), and nonobese patients (n = 16). The participants fasted for 10 h and then consumed a 200-mL liquid meal (400 kcal + 1.5 g paracetamol).Fasting and postprandial hunger, satiation, hormone concentrations, and gastric and gallbladder emptying were measured several times over 4 h. Results: No differences were observed in hunger and satiation curves between morbidly obese and nonobese groups; however, sleeve gastrectomy patients were less hungry and more satiated than the other groups. Antrum area during fasting in morbidly obese patients was statistically significant larger than in the nonobese and sleeve gastrectomy groups. Gastric emptying was accelerated in the sleeve gastrectomy group compared with the other 2 groups (which had very similar results). Gallbladder emptying was similar in the 3 groups. Sleeve gastrectomy patients showed the lowest ghrelin concentrations and higher early postprandial cholecystokinin and glucagon-like peptide 1 peaks than did the other participants. This group also showed an improved insulin resistance pattern compared with morbidly obese patients. Conclusions: Sleeve gastrectomy seems to be associated with profound changes in gastrointestinal physiology that contribute to reducing hunger and increasing sensations of satiation. These changes include accelerated gastric emptying, enhanced postprandial cholecystokinin and glucagon-like peptide 1 concentrations, and reduced ghrelin release, which together may help patients lose weight and improve their glucose metabolism after surgery. This trial was registered at clinicaltrials.gov as NCT02414893.Am J Clin Nutr 2015;102:540-7.

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Section: Discussionsupporting

confidence: 89%

Sleeve gastrectomy effects on hunger, satiation, and gastrointestinal hormone and motility responses after a liquid meal test

Mans¹,

Serra‐Prat

Palomera³

et al. 2015

The American Journal of Clinical Nutrition

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show abstract

“…They found that differences in the average values of weight, BMI, or %EWL between the 2 groups were not statistically significant. However, they concluded that even after a radical resection of the pyloric antrum, the physiologic stomach evacuation function can still be preserved [39].…”

Section: Discussionmentioning

confidence: 99%

The effect of residual gastric antrum size on the outcome of laparoscopic sleeve gastrectomy: a prospective randomized trial

Elgeidie

El-Hemaly

Hamdy

et al. 2015

Surgery for Obesity and Related Diseases

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“…Although it remains to be established, VSG-mediated increased gastric emptying or RYGB-induced redirection of intestinal nutrient flow could therefore possibly lead to enhanced L-cell responsiveness to glucose, as well as amino acids and bile acids. Indeed, VSG surgery procedures promote increased gastric emptying rates in rodents [78], [79] as well as in humans [80], [81], [82]. Nevertheless, the VSG procedure maintains delivery of macronutrients within the proximal duodenum which exhibits very few, if any, GCG-expressing cells.…”

Section: Discussionmentioning

confidence: 99%

The endogenous preproglucagon system is not essential for gut growth homeostasis in mice

Wismann

Barkholt

Secher

et al. 2017

Molecular Metabolism

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ObjectiveThe prevalence of obesity and related co-morbidities is reaching pandemic proportions. Today, the most effective obesity treatments are glucagon-like peptide 1 (GLP-1) analogs and bariatric surgery. Interestingly, both intervention paradigms have been associated with adaptive growth responses in the gut; however, intestinotrophic mechanisms associated with or secondary to medical or surgical obesity therapies are poorly understood. Therefore, the objective of this study was to assess the local basal endogenous and pharmacological intestinotrophic effects of glucagon-like peptides and bariatric surgery in mice.MethodsWe used in situ hybridization to provide a detailed and comparative anatomical map of the local distribution of GLP-1 receptor (Glp1r), GLP-2 receptor (Glp2r), and preproglucagon (Gcg) mRNA expression throughout the mouse gastrointestinal tract. Gut development in GLP-1R-, GLP-2R-, or GCG-deficient mice was compared to their corresponding wild-type controls, and intestinotrophic effects of GLP-1 and GLP-2 analogs were assessed in wild-type mice. Lastly, gut volume was determined in a mouse model of vertical sleeve gastrectomy (VSG).ResultsComparison of Glp1r, Glp2r, and Gcg mRNA expression indicated a widespread, but distinct, distribution of these three transcripts throughout all compartments of the mouse gastrointestinal tract. While mice null for Glp1r or Gcg showed normal intestinal morphology, Glp2r−/− mice exhibited a slight reduction in small intestinal mucosa volume. Pharmacological treatment with GLP-1 and GLP-2 analogs significantly increased gut volume. In contrast, VSG surgery had no effect on intestinal morphology.ConclusionThe present study indicates that the endogenous preproglucagon system, exemplified by the entire GCG gene and the receptors for GLP-1 and GLP-2, does not play a major role in normal gut development in the mouse. Furthermore, elevation in local intestinal and circulating levels of GLP-1 and GLP-2 achieved after VSG has limited impact on intestinal morphometry. Hence, although exogenous treatment with GLP-1 and GLP-2 analogs enhances gut growth, the contributions of endogenously-secreted GLP-1 and GLP-2 to gut growth may be more modest and highly context-dependent.

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Radical Resection of the Pyloric Antrum and Its Effect on Gastric Emptying After Sleeve Gastrectomy

Cited by 64 publications

References 36 publications

Sleeve gastrectomy effects on hunger, satiation, and gastrointestinal hormone and motility responses after a liquid meal test

Sleeve gastrectomy effects on hunger, satiation, and gastrointestinal hormone and motility responses after a liquid meal test

The effect of residual gastric antrum size on the outcome of laparoscopic sleeve gastrectomy: a prospective randomized trial

The endogenous preproglucagon system is not essential for gut growth homeostasis in mice

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