Introduction
Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure. Unfortunately, 30% of patients may develop persistent gastric symptoms without a mechanical cause. Gastric motility is normally coordinated by a pacemaker located at the greater curvature, which is resected in LSG, with electrophysiological consequences still undefined. This study assessed the impact of LSG on gastric electrophysiology and correlation with symptoms and quality of life (QoL), using a novel non-invasive body surface gastric mapping (BSGM) technique.
Methods
Patients with previous LSG underwent BSGM (Gastric Alimetry, New Zealand), comprising 30-minute fasting baseline and 4-hour post-prandial recordings. Analysis encompassed gastric frequency, amplitude, Gastric Alimetry Rhythm Index (GA-RI; a measure of gastric rhythm stability), compared with matched controls. Symptoms and QoL were evaluated using the validated questionnaires.
Results
38 patients (median 36 months post-surgery; range 6-119 months) and 38 controls were recruited. 37/38 patients had at least 1 abnormal gastric electrophysiology parameter, including reduced frequencies (2.4 ± 0.22 vs 3.09 ± 0.21 cycles per minute; p<0.001) and amplitudes (28.2 ± 7.1 vs 38.8 ± 15.3 uV; p<0.001). Patients showed higher symptom burdens and substantially reduced QoL (PAGI-SYM 20 vs 7, PAGI-QOL 27 vs 136, EQ-5D-5L 0.86 vs 0.96; p<0.001). Worse symptom burdens and QoL were correlated with lower gastric frequency, GA-RI and amplitude (p<0.05).
Conclusions
Laparoscopic sleeve gastrectomy modifies gastric electrophysiology due to resection of the gastric pacemaker. Consistent reduction in gastric frequency and rhythm instability correlated with worse symptoms and poorer QoL. Gastric mapping now reveals a mechanism for symptoms following sleeve gastrectomy.