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Alterations of Global Gastrointestinal Motility After Sleeve Gastrectomy: A Prospective Study

Melissas, John MD, PhD, FACS*; Leventi, Aikaterini MD*; Klinaki, Ifigeneia MD; Perisinakis, Kostas PhD; Koukouraki, Sophia MD, PhD; de Bree, Eelco MD, PhD*; Karkavitsas, Nikolaos MD, PhD

doi: 10.1097/SLA.0b013e3182774522
Original Articles

Objectives: To evaluate the role of sleeve gastrectomy (SG) in gastrointestinal motility.

Background: SG is a widely used bariatric operation leading to weight loss and early improvement of patient's metabolic profile. Current data indicate faster postoperative gastric emptying, but detailed studies on alterations in small bowel motility are missing.

Design: We evaluated 21 morbidly obese patients who underwent laparoscopic SG before and 4 months after the procedure. After consumption of a semisolid radiolabeled meal, their gastric and intestinal transit times were studied with a gamma camera. Particularly the times of 10% gastric emptying, 50% gastric emptying, maximal intestinal filling, 10% terminal ileum filling, duodenal to terminal ileum transit, cecal filling initiation, and ileocecal valve transit (T ICVt) were studied pre- and postoperatively.

Results: Ten percent gastric emptying and 50% gastric emptying were decreased postoperatively as well as maximal intestinal filling, indicating faster gastric emptying and intestinal filling. Duodenal to terminal ileum transit and 10% terminal ileum filling also decreased as small bowel transit time accelerated and the meal reached the terminal ileum more rapidly. Contrary opening of the ileocecal valve and food transit through it were delayed, with postoperative increase in cecal filling initiation and T ICVt, respectively.

Conclusions: SG accelerates gastric emptying and small bowel transit of semisolids. In addition, it delays the initiation of cecal filling and T ICVt. This early and prolonged contact of food with the distal small bowel mucosa may explain the metabolic effects of SG occurring before substantial weight loss.

Although sleeve gastrectomy is a popular bariatric procedure, its exact mechanism of action is still unknown. We aimed to clarify the pathophysiological changes resulting from this operation by scintigraphically evaluating alterations caused in gastrointestinal motility after sleeve gastrectomy.

*Bariatric Unit, Department of Surgical Oncology

Department of Nuclear Medicine, Heraklion University Hospital

Faculty of Medicine, Medical Physics Department, University of Crete, Greece.

Reprints: John Melissas, MD, PhD, FACS, Bariatric Unit, Department of Surgical Oncology, Heraklion University Hospital, University of Crete, 164 Erythreas St, 71409 Heraklion, Crete, Greece. E-mail:

J.M. and A.L. contributed equally to this work.

Disclosure: The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.