A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
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4th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY II: Mechanisms of Action FIGURE 1. Distribution of transit times (in seconds) for LSG patients Reprinted with permission from Parikh M, Eisner J, Hindman N, et al. Tests of correlation between immediate postoperative gastroduodenal transit times and weight loss after laparoscopic sleeve gastrectomy. Surg Endosc. 2012;26 (12):3548–355 DISCUSSION FIGURE 2. Scatter plots of transit time (x-axis) with weight loss measures (y-axis) at 3, 6, and 12 months post LSG *Note: Pearson's correlation coefficient was used to evaluate the linear association between the two continuous variables (weight loss and transit time). Reprinted with permission from Parikh M, Eisner J, Hindman N, et al. Tests of correlation between immediate postoperative gastroduodenal transit times and weight loss after laparoscopic sleeve gastrectomy. Surg Endosc. 2012;26(12):3548–3551. A10 Bariatric Times • May 2013 • Supplement A An increasing number of studies have shown that gastric emptying after LSG is accelerated by as much as two-fold. This raises the possibility of a potential association between accelerated gastric emptying and weight loss after LSG. The primary purpose of this study was to determine if an association existed between gastro-duodenal transit times after LSG and postoperative weight loss, specifically whether accelerated transit times correlated with improved weight loss. Ideally, if we were able to determine a positive correlation between immediate postoperative transit times and longer term weight loss, then one could focus on LSG surgical technique strategies that may accelerate transit times, such as preserving the antrum or utilizing a tighter bougie. Unfortunately, we found no significant correlation between gastroduodenal transit time and weight loss. Our negative findings are contradictory to the recent findings of Pomerri et al.1 In this study, sleeve voiding in 57 LSG patients was categorized as either "fast" (<1 minute) or "slow" (>1 minute); their primary finding was that the LSG patients who emptied "faster" had better weight loss at one year (56% EWL vs. 30% EWL). In our study, 99 percent of our patients voided less than one minute; therefore, a similar dichotomization would not be feasible. We dichotomized our patients into either less than 30 seconds or more than 30 seconds and still found no correlation with weight loss. A more recent study2 dichotomized patients into less than 30 seconds and more than 30 seconds and found that the patients with slower transit lost more weight. Correlation tests were not performed. Also, the bougie size changed over the course of the study and patients with previous bariatric surgery (16–22%) were not excluded. Clearly, more studies are necessary to determine the relationship between gastroduodenal transit after LSG and weight loss. Future studies should utilize correlation tests first rather than a priori dichotomizing the data to determine if a relationship truly exists. CONCLUSION We found no correlation between gastro-duodenal transit and weight loss after LSG. REFERENCES 1. 2. Pomerri F, Foletto M, Allegro G et al. Sleeve gastrectomy—radiological assessment of fundus size and sleeve voiding. Obes Surg. 2011;21(7):858–863. Goitein D, Zendel A, Westrich G et al. Postoperative swallow study as a predictor of intermediate weight loss after sleeve gastrectomy. Obes Surg. 2013;23:222–225.