open9noAims and objectives
Laparoscopic Sleeve Gastrectomy (LSG) is considered safe and effective even as
conversion procedure after primary bariatric operations. The correlation between gastric
pouch volumes and gastro-esophageal reflux disease's (GERD) symptoms (heartburn,
reflux, regurgitation) remains unclear (1, 2).
With this study we want to assess a correlation between the gastric remnant size and
GERD.openPomerri, F.; Romanucci, G.; Barbiero, G.; Zuliani, M.; Ortu, V.; Miotto, D.; Albanese, A.; Prevedello, L.; Foletto, M.Pomerri, Fabio; Romanucci, G.; Barbiero, G.; Zuliani, M.; Ortu, V.; Miotto, Diego; Albanese, A.; Prevedello, L.; Foletto, M

Albanese, A.

Barbiero, G.

Foletto, M.

Miotto, Diego

Ortu, V.

Pomerri, Fabio

Prevedello, L.

Romanucci, G.

Zuliani, M.

English

Aims and objectives
Laparoscopic Sleeve Gastrectomy (LSG) is considered safe and effective even as
conversion procedure after primary bariatric operations. The correlation between gastric
pouch volumes and gastro-esophageal reflux disease's (GERD) symptoms (heartburn,
reflux, regurgitation) remains unclear (1, 2).
With this study we want to assess a correlation between the gastric remnant size and
GERD

POMERRI, FABIO

MIOTTO, DIEGO

Archivio istituzionale della ricerca - Università di Padova

Original Citation:Relationship between gastric pouch and GERD after laparoscopic sleeve gastrectomyEuropean Society of RadiologyPublisher:Published version:DOI:Terms of use:Open Access(Article begins on next page)This article is made available under terms and conditions applicable to Open Access Guidelines, as described athttp://www.unipd.it/download/file/fid/55401 (Italian only)Availability:This version is available at: 11577/3211110 since: 2016-11-30T08:40:06Z10.1594/ecr2016/C-0184Università degli Studi di PadovaPadua Research Archive - Institutional RepositoryPage 1 of 9Relationship between gastric pouch and GERD afterlaparoscopic sleeve gastrectomyPoster No.: C-0184Congress: ECR 2016Type: Scientific ExhibitAuthors: F. Pomerri, G. Romanucci, G. Barbiero, M. Zuliani, V. Ortu, D.Miotto, A. albanese, L. prevedello, M. Foletto; Padova (PD)/ITKeywords: Eating disorders, Imaging sequences, Contrast agent-oral,Conventional radiography, Gastrointestinal tractDOI: 10.1594/ecr2016/C-0184Any information contained in this pdf file is automatically generated from digital materialsubmitted to EPOS by third parties in the form of scientific presentations. Referencesto any names, marks, products, or services of third parties or hypertext links to third-party sites or information are provided solely as a convenience to you and do not inany way constitute or imply ECR's endorsement, sponsorship or recommendation of thethird party, information, product or service. ECR is not responsible for the content ofthese pages and does not make any representations regarding the content or accuracyof material in this file.As per copyright regulations, any unauthorised use of the material or parts thereof aswell as commercial reproduction or multiple distribution by any traditional or electronicallybased reproduction/publication method ist strictly prohibited.You agree to defend, indemnify, and hold ECR harmless from and against any and allclaims, damages, costs, and expenses, including attorneys' fees, arising from or relatedto your use of these pages.Please note: Links to movies, ppt slideshows and any other multimedia files are notavailable in the pdf version of presentations.www.myESR.orgPage 2 of 9Aims and objectivesLaparoscopic Sleeve Gastrectomy (LSG) is considered safe and effective even asconversion procedure after primary bariatric operations. The correlation between gastricpouch volumes and gastro-esophageal reflux disease's (GERD) symptoms (heartburn,reflux, regurgitation) remains unclear (1, 2).With this study we want to assess a correlation between the gastric remnant size andGERD.Methods and materialsTo assess a correlation between the gastric remnant size and GERD, we reviewed 49consecutive barium-swallow UGS performed at our Institute from August 2012 throughMay 2014 in LSG patients with symptoms and/or unsatisfactory weight loss.The mean interval from surgery to UGS was 1.96±2.48 years.Patients were asked to fasten for at least 4 hours before barium swallow.Patients' data (height, weight before surgery, lowest weight reached, present weight,place and date of surgery) were retrieved/collected, symptoms if present registered.All exams were performed with Siemens AXIOM Iconos R200 (Siemens, Erlangen,Germany), administering an oral suspension obtained with barium diluted in 100 ml ofwater (Prontobario H.D., 98.45g of barium sulfate) (Bracco, Milan, Italy).Images have been registered at a frequency of 2 frames per second, with patient inorthostatic position. A first plain antero-posterior radiogram of the upper abdomen wasobtained (Fig.1). Then, the patient in the upfront position was instructed to swallow asmall amount of contrast medium, registering the passage of barium from the middle-distal third of the oesophagus through the stomach (Fig.2). A second series of imageswas obtained from the lateral view with the same characteristics (Fig.3). When needed,further projections were added to better evaluate pouches in association with provocativemaneuvers to stimulate gastro-oesophageal reflux, even in supine position. The passageof barium through the pylorus into the duodenum was also recorded. (3, 4)Each study was assessed by two expert gastro-intestinal tract Radiologists. When apouch was identified, it was measured along its three major axes (antero-posterior AP,cranio-caudal CC, and latero-lateral LL diameters) and the volume was calculated withthe ellipsoid formula (AP x CC x LL x 0.5). Patients were divided into two groups: group1, without a detectable pouch (n=36) and group 2 with a detectable gastric pouch (n=13).Page 3 of 9To evaluate the presence of GERD was used a questionnaire of 10 questions for thediagnosis of GERD and the subsequent 6 to assess the presence of atypical symptoms(5).Correlation between pouch volume and GERD was calculated with Fisher test to relateGERD symptoms to fundic pouch. P<0.05 was considered statistically significant.Images for this section:Page 4 of 9Fig. 1: W, 41 yrs. Plain x-ray of the epigastric region, which shows the presence of anair-fluid level in the left hypochondrium© - Padova (PD)/ITPage 5 of 9Fig. 2: Same patient as fig. 1, standing in orthostatic, frontal position; after the first sip ofcontrast medium, an ellissoid-shaped plus-image appears in the first trait of the sleevedstomach, protruding toward the right side. The air-fluid level is still visible.© - Padova (PD)/ITPage 6 of 9Fig. 3: Same patient as figs.1 and 2, standing in orthostatic, left-lateral position; the plusimage is fully visible in its complete extension. The continuity with the air-fluid level isnow evident.© - Padova (PD)/ITPage 7 of 9ResultsTwenty-six patients had a history of previous abdominal surgery: 13/49 laparoscopicadjustable gastric band (LAGB) before LSG, 9/49 cholecistectomy, 2/49 abdominoplasty,4/49 other major abdominal surgery.Twenty-seven patients experienced one or more of these symptoms: dysphagia (2/49),dyspepsia (8/49), reflux and heartburn (18/49), vague stomachache (4/49), nausea and/or vomit (6/49). The remaining 22 patients were asymptomatic, except from unsatisfactoryweight loss or weight regain.A gastric pouch was found in 13 out of 49 patients (Group 2), while the 36 remainingpatients had not such an evidence (Group 1). The mean volume of the pouch was17,13±21.56 mm3.The relationship between GERD symptoms (heartburn, reflux, regurgitation) and theevidence of pouch was not significant in our series, as 7 out of the 13 patients with pouchand 17 out of the 36 patients without pouch had symptoms of GERD, with an incidenceof 53,84% and 47.22%, respectively.ConclusionGERD symptoms had the same distribution in symptomatic or unsatisfactory weight losspopulation with or without fundic pouch. The lack of significant correlation between pouchevidence and GERD symptoms needs further investigation, encompassing thoroughprior-to-LSG specific validated questionnaire and clinical assessment, keeping in mindthat the obesity is an independent factor for GERD.Personal informationAuthors and Affiliations:Fabio Pomerri MD*, Giovanna Romanucci MD*, Giulio Barbiero MD*, Monica ZulianiMD*, Valeria Ortu MD*, Diego Miotto MD*,Alice Albanese MD**, Luca Prevedello MD**, Mirto Foletto MD**Page 8 of 9*University Radiology, Department of Medicine, University Hospital of Padua, 2 ViaGiustiniani, 35128, Padova (PD), Italy.**Center of excellence for Bariatric and Metabolic Surgery, University Hospital of Padua,2 Via Giustiniani, 35128, Padova (PD), Italy.Work performed in University Hospital of Padua, 2 via Giustiniani, 35128 Padova (PD),Italy.Correspondance to:Giovanna Romanucci MD, University Radiology, Department of Medicine, UniversityHospital of Padua, 2 Via Giustiniani, 35128, Padova (PD), Italy.E-mail: giovi.romanucci@libero.itTelephone: +39-049-8212366 Fax: +39-049-8218172; 049-8218172.References1. Pagè MP, Kastenmeier A, Goldblatt M, Frelich M, Bosler M, Wallace J, Gould J(2014)Medically refractory gastroesophageal reflux disease in the obese: what is the bestsurgical approach? Surg Endosc. DOI: 10.1007/s00464-013-3343-3. 2013 Dec 62. Lazoura O, Zacharoulis D, Triantafyllidis G, Fanariotis M, Sioka E, Papamargaritis D,Tzovaras G (2011) Symptoms of gastroesophageal reflux following laparoscopic sleevegastrectomy are related to the final shape of the sleeve as depicted by radiology. ObesSurg; 21:295-2993. Kleidi E, Theodorou D, Albanopoulos K, Menenakos E, Karvelis MA, Papailiou J,Stamou K, Zografos G, Katsaragakis S, Leandros E (2013) The effect of laparoscopicsleeve gastrectomy on the antireflux mechanism: can it be minimized? Surg Endosc.DOI: 10.1007/s00464-013-3083-4. 2013 Jul 94 Toro JP, Lin E, Patel AD, Davis SS Jr, Sanni A, Urrego HD (2014) Association ofradiographic morphology with early gastroesophageal reflux disease and satiety controlafter sleeve gastrectomy. J Am Coll Surg Sept; Vol 219, N°3Page 9 of 95. Triantafyllidis G, Lazoura O, Sioka E, Tzovaras G, Antoniou A, Vassiou K, ZacharoulisD (2011) Anatomy and complications following laparoscopic sleeve gastrectomy:radiological evaluation and imaging pitfalls. Obes Surg. Apr;21(4):473-478

Relationship between gastric pouch and GERD after laparoscopic sleeve gastrectomy

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Relationship between gastric pouch and GERD after laparoscopic sleeve gastrectomy

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