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4th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY II: Mechanisms of Action Does Sleeve Transit Correlate with Weight Loss? by MANISH PARIKH, MD Bariatric Times. 2013;10(5 Suppl A):A9–A10 AUTHOR AFFILIATIONS: Dr. Parikh is Assistant Professor of Surgery, New York University School of Medicine, New York, New York, and Director of Bariatric and Minimally Invasive Surgery, Bellevue Hospital, New York, New York. ADDRESS FOR CORRESPONDENCE: Manish Parikh, MD, 550 First Avenue NBV 15 South 7, New York, NY 10016; Phone: (212) 2638187; Fax: (212) 263-8640; E-mail: manish.parikh@nyumc.org FUNDING: This project was supported by a grant from the Agency for Healthcare Research and Quality (K12HS019473). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. DISCLOSURES: This is an extended abstract based on a previously published study: 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. KEY POINTS • Gastric emptying is accelerated after sleeve gastrectomy. • It is unclear if more rapid transit leads to more weight loss after LSG—we found no correlation. • Future studies should use correlation tests rather than dichotomizing the data a priori. L aparoscopic sleeve gastrectomy (LSG) is increasing in popularity as a primary procedure for weight loss. Previous studies have shown accelerated gastric emptying after LSG. The purpose of this study was to determine if a correlation exists between immediate post-operative gastro-duodenal transit time and weight loss after LSG. Specifically, we conducted correlation tests to determine whether more rapid transit after LSG correlated with increased weight loss. METHODS Data was collected from an Institutional Review Board (IRB)- approved electronic registry, including patient demographics, weight, and body mass index (BMI). All LSG procedures were performed with 40Fr Bougie, starting 5 to 7cm proximal to pylorus, using Endo-GIA 60-4.8mm (Covidien, Mansfield, Massachusetts) cartridges buttressed with Seamguard Bioabsorbable Stapleline Reinforcement (W.L. Gore and Associates, Inc., Flagstaff, Arizona). Postoperative esophagrams were performed routinely as part of our clinical protocol on Postoperative Day 1. Esophagrams were performed in the upright position, after the administration of 100–250cc oral gastrograffin. Fluoroscopic images were captured after contrast passed the esophagus, gastroesophageal junction, stomach (body and antrum), and duodenum (to the second portion). These esophagrams were evaluated retrospectively by two board-certified attending radiologists who specialized in body imaging to calculate antrum-to-duodenum transit times. Consensus reads were utilized for divergent opinions. Pearson's correlation coefficient was used for statistical analysis. RESULTS Sixty-two patients underwent LSG (21% concurrent hiatal hernia repair) between January 2009 and January 2011 at our institution. Eighty-four percent of the population were women. The average preoperative age and BMI were 42±12.4 years and 47.0±7.5kg/m2, respectively. The mean gastroduodenal transit time (available in 60 patients) was 21.3±19.8 seconds [0–88]. Ninety-nine percent of the patients had transit time less than 60 seconds (Figure 1). No correlation was found between transit time and percentage of excess weight loss (%EWL) at 3, 6 or 12 months (Figure 2). After we divided our data between those with transit time less than 30 seconds versus more than 30 seconds, there was still no significant correlation. Transit time was not associated with any patient characteristics (e.g., BMI, age, gender). May 2013 • Supplement A • Bariatric Times A9