Alterations of Global Gastrointestinal Motility After Sleeve Gastrectomy

Abstract

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.