The Effect of Sleeve Gastrectomy on Gastroparesis: A Short Clinical Review

Abstract

Introduction:

Although laparoscopic sleeve gastrectomy (LSG) is currently the most commonly performed bariatric procedure, its mechanism of action is debated. Although a commonly held belief is that LSG retards the flow of food through the upper gastrointestinal tract, increasing evidence suggests that LSG results in augmented gastric emptying. If true, LSG may have beneficial effects on the management of individuals with gastroparesis. We present two case reports of LSG in the setting of gastroparesis.

Methods:

Case report and literature review using Pubmed. Search terms included sleeve gastrectomy, gastric emptying, gastroparesis, bougie size, and leak.

Case Description—Case 1:

A 50-year-old female with morbid obesity and idiopathic gastroparesis, as evidenced by subjective symptoms of heartburn and regurgitation, presented for bariatric surgery. Gastroparesis was confirmed by nuclear scintigraphy, demonstrating 0% emptying of scrambled egg meal by 120 min. Six weeks after LSG, the symptoms of regurgitation were markedly reduced. A repeat nuclear scintigraphy study documented normalization of gastric emptying, with a T½ of 90 min. At 2 years postoperatively, she had lost 51% of excess body weight.

Case 2:

A 40-year-old female with morbid obesity and gastroparesis, with subjective symptoms of upper abdominal bloating, presented for bariatric surgery. She had type 2 diabetes mellitus, but had excellent glycemic control as evidenced by Hgb-A1c of 6.3%. Nuclear scintigraphy study with scrambled eggs demonstrated minimal emptying by 120 min. By 6 weeks after LSG, there were no symptoms of gastroparesis, and repeat nuclear scintigraphy documented 45% emptying by 117 min. At 3 months, she had lost 14% of excess body weight.

Discussion:

Our case reports and the literature suggest that LSG functions by augmentation of gastric emptying, and that this procedure may have some utility for the management of idiopathic gastroparesis. To date, studies of gastric emptying are few and differ in many ways. Studies that focus on gastric emptying performed with robust methodology could result in the appropriate selection of patients with gastroparesis who may benefit from LSG.