Pouch Emptying After Bypass May Predict Weight Loss

PHILADELPHIA — Patients with slow or no gastric pouch emptying on an upper GI study 1 day after undergoing laparoscopic Roux-en-Y gastric bypass may have less weight loss at 1 year than would patients with normal, prompt pouch emptying, according to a prospective study of 405 patients.

The study's findings could add another reason to perform a routine upper GI procedure, Dr. Ehab A. El Akkary said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

On evaluation, some gastric bypass patients show no or very slow emptying of contrast agent from the gastric pouch to the Roux limb of the jejunum, while others show fast emptying.

Dr. El Akkary and his associates conducted a prospective study of 405 patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) performed by one surgeon with a linear stapler technique during 2002–2006. All patients underwent an upper GI study on postoperative day 1.

Of 304 patients with 1 year of follow-up, 188 had normal, prompt pouch emptying and 116 had slow or nonemptying pouches, said Dr. El Akkary, a fellow in the gastrointestinal surgery division at Yale University, New Haven, Conn.

At 1 year after LRYGB, patients with prompt pouch emptying lost significantly more weight than did patients with delayed pouch emptying (111 pounds vs. 104 pounds), and had a lower mean body mass index (31.7 vs. 35.6 kg/m

The gastric pouches were roughly the same size in the two groups, Dr. El Akkary said. None of the patients required dilatation or a reoperation, and none had dumping syndrome.

Because the two groups were similar in terms of age, operative time, length of hospital stay, and initial weight and BMI, Dr. El Akkary and his colleagues noted that an increase in peptide YY might explain the findings. Peptide YY is known to reduce appetite in response to eating. Although no hormonal data are available to support this hypothesis, the next phase of the study will measure the level of peptide YY to “see if it can explain this discrepancy in weight loss,” said Dr. El Akkary, who reported having no conflicts of interest.

An audience member cautioned that although the data were intriguing, the actual difference in weight loss was small and the size of the pouch may have changed over the course of the year. Dr. El Akkary agreed that the lack of a repeat upper GI procedure at 1 year was a limitation of the study, adding that it would be especially helpful in detecting patients with slow gastric emptying caused by edema at the gastrojejunostomy.

The investigators did not measure the patients' preoperative rate of gastric emptying, but another audience member suggested that it would be “very important because it could be predictive of outcome.”

PHILADELPHIA — Patients with slow or no gastric pouch emptying on an upper GI study 1 day after undergoing laparoscopic Roux-en-Y gastric bypass may have less weight loss at 1 year than would patients with normal, prompt pouch emptying, according to a prospective study of 405 patients.

The study's findings could add another reason to perform a routine upper GI procedure, Dr. Ehab A. El Akkary said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

On evaluation, some gastric bypass patients show no or very slow emptying of contrast agent from the gastric pouch to the Roux limb of the jejunum, while others show fast emptying.

Dr. El Akkary and his associates conducted a prospective study of 405 patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) performed by one surgeon with a linear stapler technique during 2002–2006. All patients underwent an upper GI study on postoperative day 1.

Of 304 patients with 1 year of follow-up, 188 had normal, prompt pouch emptying and 116 had slow or nonemptying pouches, said Dr. El Akkary, a fellow in the gastrointestinal surgery division at Yale University, New Haven, Conn.

At 1 year after LRYGB, patients with prompt pouch emptying lost significantly more weight than did patients with delayed pouch emptying (111 pounds vs. 104 pounds), and had a lower mean body mass index (31.7 vs. 35.6 kg/m

The gastric pouches were roughly the same size in the two groups, Dr. El Akkary said. None of the patients required dilatation or a reoperation, and none had dumping syndrome.

Because the two groups were similar in terms of age, operative time, length of hospital stay, and initial weight and BMI, Dr. El Akkary and his colleagues noted that an increase in peptide YY might explain the findings. Peptide YY is known to reduce appetite in response to eating. Although no hormonal data are available to support this hypothesis, the next phase of the study will measure the level of peptide YY to “see if it can explain this discrepancy in weight loss,” said Dr. El Akkary, who reported having no conflicts of interest.

An audience member cautioned that although the data were intriguing, the actual difference in weight loss was small and the size of the pouch may have changed over the course of the year. Dr. El Akkary agreed that the lack of a repeat upper GI procedure at 1 year was a limitation of the study, adding that it would be especially helpful in detecting patients with slow gastric emptying caused by edema at the gastrojejunostomy.

The investigators did not measure the patients' preoperative rate of gastric emptying, but another audience member suggested that it would be “very important because it could be predictive of outcome.”

PHILADELPHIA — Patients with slow or no gastric pouch emptying on an upper GI study 1 day after undergoing laparoscopic Roux-en-Y gastric bypass may have less weight loss at 1 year than would patients with normal, prompt pouch emptying, according to a prospective study of 405 patients.

The study's findings could add another reason to perform a routine upper GI procedure, Dr. Ehab A. El Akkary said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

On evaluation, some gastric bypass patients show no or very slow emptying of contrast agent from the gastric pouch to the Roux limb of the jejunum, while others show fast emptying.

Dr. El Akkary and his associates conducted a prospective study of 405 patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) performed by one surgeon with a linear stapler technique during 2002–2006. All patients underwent an upper GI study on postoperative day 1.

Of 304 patients with 1 year of follow-up, 188 had normal, prompt pouch emptying and 116 had slow or nonemptying pouches, said Dr. El Akkary, a fellow in the gastrointestinal surgery division at Yale University, New Haven, Conn.

At 1 year after LRYGB, patients with prompt pouch emptying lost significantly more weight than did patients with delayed pouch emptying (111 pounds vs. 104 pounds), and had a lower mean body mass index (31.7 vs. 35.6 kg/m

The gastric pouches were roughly the same size in the two groups, Dr. El Akkary said. None of the patients required dilatation or a reoperation, and none had dumping syndrome.

Because the two groups were similar in terms of age, operative time, length of hospital stay, and initial weight and BMI, Dr. El Akkary and his colleagues noted that an increase in peptide YY might explain the findings. Peptide YY is known to reduce appetite in response to eating. Although no hormonal data are available to support this hypothesis, the next phase of the study will measure the level of peptide YY to “see if it can explain this discrepancy in weight loss,” said Dr. El Akkary, who reported having no conflicts of interest.

An audience member cautioned that although the data were intriguing, the actual difference in weight loss was small and the size of the pouch may have changed over the course of the year. Dr. El Akkary agreed that the lack of a repeat upper GI procedure at 1 year was a limitation of the study, adding that it would be especially helpful in detecting patients with slow gastric emptying caused by edema at the gastrojejunostomy.

The investigators did not measure the patients' preoperative rate of gastric emptying, but another audience member suggested that it would be “very important because it could be predictive of outcome.”