TY - JOUR
T1 - Association of radiographic morphology with early gastroesophageal reflux disease and satiety control after sleeve gastrectomy
AU - Toro, Juan P.
AU - Lin, Edward
AU - Patel, Ankit D.
AU - Davis, S. Scott
AU - Sanni, Aliu
AU - Urrego, Hernan D.
AU - Sweeney, John F.
AU - Srinivasan, Jahnavi K.
AU - Small, William
AU - Mittal, Pardeep Kumar
AU - Sekhar, Aarti
AU - Moreno, Courtney C.
N1 - Funding Information:
Drs Patel, Sanni, and Urrego are funded in part by the Foundation for Surgical Fellowships .
PY - 2014/9
Y1 - 2014/9
N2 - Background Variable gastric morphology has been identified on routine upper gastrointestinal series after laparoscopic sleeve gastrectomy. This test might give us useful information beyond the presence of leak and obstruction. The aim of this study is to standardize a morphologic classification of gastric sleeve based on water-soluble contrast upper gastrointestinal series, and to determine possible clinical implications. Study Design One hundred morbidly obese patients underwent laparoscopic sleeve gastrectomy and had routine upper gastrointestinal on postoperative day 1 or 2. Images were reviewed by 4 radiologists who were blinded to outcomes, and sleeve shape was classified as upper pouch, lower pouch, tubular, or dumbbell. Inter-observer agreement was calculated. Clinical outcomes including weight loss, satiety control, and reflux symptoms were recorded. Comparisons were determined by 1-way ANOVA and t-test. Results Mean age was 46 ± 12 years and mean BMI was 45.1 ± 6 kg/m2. Overall inter-observer agreement level for the sleeve shape classification was 76.3%. Sleeve shapes were tubular in 37%, dumbbell in 32%, lower pouch in 22%, and upper pouch in 8%. Mean excess body weight loss at 1, 3, and 6 months was 16.8%, 29.9%, and 39.1%, respectively. Excess body weight loss was not associated with sleeve shape. Mean hunger score was 213 ± 97, and patients with dumbbell shape had higher hunger scores (p = 0.003). Mean reflux score was 5.7 ± 8. Upper pouch shape was associated with greater severity of reflux symptoms (p = 0.02). Conclusions This study suggests a standardized radiographic classification of gastric sleeve morphology. Although sleeve shape is not correlated with weight loss, gastric sleeves with retained fundus result in lower satiety control and higher severity of reflux symptoms. An adequate resection of the gastric fundus might avoid this potential complication.
AB - Background Variable gastric morphology has been identified on routine upper gastrointestinal series after laparoscopic sleeve gastrectomy. This test might give us useful information beyond the presence of leak and obstruction. The aim of this study is to standardize a morphologic classification of gastric sleeve based on water-soluble contrast upper gastrointestinal series, and to determine possible clinical implications. Study Design One hundred morbidly obese patients underwent laparoscopic sleeve gastrectomy and had routine upper gastrointestinal on postoperative day 1 or 2. Images were reviewed by 4 radiologists who were blinded to outcomes, and sleeve shape was classified as upper pouch, lower pouch, tubular, or dumbbell. Inter-observer agreement was calculated. Clinical outcomes including weight loss, satiety control, and reflux symptoms were recorded. Comparisons were determined by 1-way ANOVA and t-test. Results Mean age was 46 ± 12 years and mean BMI was 45.1 ± 6 kg/m2. Overall inter-observer agreement level for the sleeve shape classification was 76.3%. Sleeve shapes were tubular in 37%, dumbbell in 32%, lower pouch in 22%, and upper pouch in 8%. Mean excess body weight loss at 1, 3, and 6 months was 16.8%, 29.9%, and 39.1%, respectively. Excess body weight loss was not associated with sleeve shape. Mean hunger score was 213 ± 97, and patients with dumbbell shape had higher hunger scores (p = 0.003). Mean reflux score was 5.7 ± 8. Upper pouch shape was associated with greater severity of reflux symptoms (p = 0.02). Conclusions This study suggests a standardized radiographic classification of gastric sleeve morphology. Although sleeve shape is not correlated with weight loss, gastric sleeves with retained fundus result in lower satiety control and higher severity of reflux symptoms. An adequate resection of the gastric fundus might avoid this potential complication.
KW - Abbreviations and Acronyms
KW - EBWL
KW - HRQL
KW - Health-Related Quality of Life
KW - LSG
KW - POD
KW - UGI
KW - excess body weight loss
KW - laparoscopic sleeve gastrectomy
KW - postoperative day
KW - upper gastrointestinal series
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U2 - 10.1016/j.jamcollsurg.2014.02.036
DO - 10.1016/j.jamcollsurg.2014.02.036
M3 - Article
C2 - 25026879
AN - SCOPUS:84906794535
SN - 1072-7515
VL - 219
SP - 430
EP - 438
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 3
ER -