Daniel Riccioppo1, Marco Aurelio Santo2, Manoel Rocha3, Carlos Alberto Buchpiguel4, Marcio Augusto Diniz5, Denis Pajecki2, Roberto de Cleva2, Flavio Kawamoto2. 1. Department of Digestive Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, Rua Oscar Freire 2250 - CJ 314, São Paulo, SP, 05409-011, Brazil. danriccioppo@me.com. 2. Department of Digestive Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, Rua Oscar Freire 2250 - CJ 314, São Paulo, SP, 05409-011, Brazil. 3. Institute of Radiology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil. 4. Nuclear Medicine Center, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil. 5. Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, USA.
Abstract
INTRODUCTION: Anatomical and functional influences on gastric bypass (GBP) results are often poorly evaluated and not yet fully understood. PURPOSE: The purpose of this study is to evaluate the influence of the gastric pouch volume and its emptying rate on long-term weight loss and food tolerance after GBP. MATERIALS AND METHODS: Weight loss, food tolerance, pouch volumetry (V) by three-dimensional reconstruction, and pouch emptying rate by 4 h scintigraphy were evaluated in 67 patients. Cutoffs were identified for V and retention percentage (%Ret) at 1 h (%Ret1). From these parameters, the sample was categorized, looking for associations between V, %Ret, weight loss, and food tolerance, assessed by a questionnaire for quick assessment of food tolerance (SS). RESULTS: PO median follow-up time was 47 months; median V was 28 mL; %Ret at 1, 2, and 4 h were 8, 2, and 1%, respectively. There were associations between V ≤ 40 mL and higher emptying rates up to 2 h (V ≤ 40 mL: %Ret1 = 6, %Ret2 = 2, p = 0.009; V > 40 mL: %Ret1 = 44, %Ret2 = 13.5, p = 0.045). An association was found between higher emptying speed in 1 h and higher late weight loss (WL), represented by lower percentage of excess weight loss (%EWL) regain (p = 0.036) and higher %EWL (p = 0.033) in the group with %Ret1 ≤ 12%, compared to the group %Ret1 ≥ 25%. Better food tolerance (SS > 24), was associated with lower %Ret1 (p = 0.003). CONCLUSION: Smaller pouch size is associated with a faster gastric emptying, greater WL maintenance, and better food tolerance. These data suggest that a small pouch with rapid emptying rate is an important technical parameter for good outcomes in GBP.
INTRODUCTION: Anatomical and functional influences on gastric bypass (GBP) results are often poorly evaluated and not yet fully understood. PURPOSE: The purpose of this study is to evaluate the influence of the gastric pouch volume and its emptying rate on long-term weight loss and food tolerance after GBP. MATERIALS AND METHODS:Weight loss, food tolerance, pouch volumetry (V) by three-dimensional reconstruction, and pouch emptying rate by 4 h scintigraphy were evaluated in 67 patients. Cutoffs were identified for V and retention percentage (%Ret) at 1 h (%Ret1). From these parameters, the sample was categorized, looking for associations between V, %Ret, weight loss, and food tolerance, assessed by a questionnaire for quick assessment of food tolerance (SS). RESULTS: PO median follow-up time was 47 months; median V was 28 mL; %Ret at 1, 2, and 4 h were 8, 2, and 1%, respectively. There were associations between V ≤ 40 mL and higher emptying rates up to 2 h (V ≤ 40 mL: %Ret1 = 6, %Ret2 = 2, p = 0.009; V > 40 mL: %Ret1 = 44, %Ret2 = 13.5, p = 0.045). An association was found between higher emptying speed in 1 h and higher late weight loss (WL), represented by lower percentage of excess weight loss (%EWL) regain (p = 0.036) and higher %EWL (p = 0.033) in the group with %Ret1 ≤ 12%, compared to the group %Ret1 ≥ 25%. Better food tolerance (SS > 24), was associated with lower %Ret1 (p = 0.003). CONCLUSION: Smaller pouch size is associated with a faster gastric emptying, greater WL maintenance, and better food tolerance. These data suggest that a small pouch with rapid emptying rate is an important technical parameter for good outcomes in GBP.
Authors: Jeffrey I Mechanick; Robert F Kushner; Harvey J Sugerman; J Michael Gonzalez-Campoy; Maria L Collazo-Clavell; Safak Guven; Adam F Spitz; Caroline M Apovian; Edward H Livingston; Robert Brolin; David B Sarwer; Wendy A Anderson; John Dixon Journal: Surg Obes Relat Dis Date: 2008-08-19 Impact factor: 4.734
Authors: Santiago Horgan; Garth Jacobsen; G Derek Weiss; John S Oldham; Peter M Denk; Frank Borao; Steven Gorcey; Brad Watkins; John Mobley; Kari Thompson; Adam Spivack; Dave Voellinger; Chris Thompson; Lee Swanstrom; Paresh Shah; Greg Haber; Matthew Brengman; Gregory Schroder Journal: Surg Obes Relat Dis Date: 2010-02-13 Impact factor: 4.734
Authors: Guilherme M Campos; Charlotte Rabl; Kathleen Mulligan; Andrew Posselt; Stanley J Rogers; Antonio C Westphalen; Feng Lin; Eric Vittinghoff Journal: Arch Surg Date: 2008-09
Authors: C Dirksen; M Damgaard; K N Bojsen-Møller; N B Jørgensen; U Kielgast; S H Jacobsen; L S Naver; D Worm; J J Holst; S Madsbad; D L Hansen; J L Madsen Journal: Neurogastroenterol Motil Date: 2013-01-29 Impact factor: 3.598
Authors: Galzuinda Maria Figueiredo Reis; Carlos Alberto Malheiros; Paulo Roberto Savassi-Rocha; Omar Lopes Cançado Júnior; Fábio Rodrigues Thuler; Mauro Lima Faria; Vicente Guerra Filho Journal: Obes Surg Date: 2019-02 Impact factor: 4.129