Sleeve gastrectomy brings about significant anatomical and physiological alterations of the esophagus and stomach, including food tolerance. Currently, there is no consensus on the parameters of abnormal esophageal transit and gastric emptying in this population. We aimed to describe a standardized esophageal transit and gastric emptying protocols, and to define the normative values specific to the sleeve gastrectomy.
Forty-three asymptomatic optimal post sleeve gastrectomy patients a standardized liquid and semi-solid (oatmeal) esophageal transit, plus a 90-minute semi-solid gastric emptying study with dynamic 5-seconds image acquisition. Gastric emptying half-time and retention rate were calculated. Esophageal transit and reflux were graded qualitatively.
Thirty-one female and 12 male patients participated; mean age 49.0±10.7 years, pre-operative BMI 47.6±7.0 kg/m2, excess weight loss 58.8±26.0% at median follow-up of 7.4 months. The standardized semi-solid meal and liquid preparation were well tolerated. Delays in transit of liquid and solid boluses were infrequent (7.0% vs. 16.3%, p=0.313). Deglutitive reflux of both substances was common (48.8% vs. 32.6%, p=0.838). The median gastric emptying half-time of the cohort was 21.0 minutes (IQR 9.0). The median stomach retentions were 97.4%, 47.1%, 24.9%, 16.5%, and 10.8% at 5, 25, 50, 75, and 90 minutes. Reflux events during gastric emptying were common (median 5.0 events, 12.7% of image acquisition time).
Rapid gastric emptying and asymptomatic reflux events are expected post sleeve gastrectomy. We have defined the normative values of a standardized esophageal transit and gastric emptying scintigraphy specifically tailored to post sleeve gastrectomy patients.