Abnormal gastric electrophysiology following laparoscopic sleeve gastrectomy and associations with symptoms and quality of life

BACKGROUND: Sleeve gastrectomy is an effective bariatric procedure but may lead to persistent symptoms without obvious mechanical cause. The normal gastric pacemaker region, which lies on the greater curvature of the corpus, is resected in sleeve gastrectomy, but the electrophysiological consequences are not adequately defined. This study assessed these impacts and associations with symptoms and quality of life (QoL) using non-invasive gastric mapping.

METHODS: Patients with previous sleeve gastrectomy underwent body surface gastric mapping (Gastric Alimetry), comprising 30-minute fasting baseline and 4-hour post-prandial recordings. Analysis encompassed principal gastric frequency (PGF), body mass index-adjusted amplitude, and the Gastric Alimetry Rhythm Index (GA-RI), with comparison to reference intervals and matched controls. Symptoms were evaluated using a validated app and questionnaires.

RESULTS: The study recruited 38 patients (median 36 months after surgery; range 6-119 months) and 38 controls. Of the 38 patients, 35 had at least one abnormal parameter compared with controls, typically reduced frequencies (mean(standard deviation) 2.30(0.34) versus 3.08(0.21) c.p.m., respectively; P < 0.001) and amplitudes (14.8(6.9) versus 31.5(18.0) µV, respectively; P < 0.001). Patients exhibited higher symptoms and lower QoL than the controls (Patient Assessment of Upper Gastrointestinal Disorders (PAGI) Symptoms Questionnaire scores 20 versus 7, respectively (P < 0.001); PAGI-QOL 27 versus 136, respectively (P < 0.001)). Gastric amplitude (R = 0.71, P < 0.001) and the GA-RI (R = 0.60, P = 0.02) were positively correlated with bloating, whereas amplitude was negatively correlated with heartburn (R = -0.46, P = 0.03). Lower gastric amplitudes were also correlated with greater weight loss (R = -0.45; P = 0.014).

CONCLUSION: Sleeve gastrectomy modifies gastric electrophysiology due to pacemaker resection, with variable remodelling. Substantial reductions in gastric frequency and amplitude occur routinely after surgery, with specific associations between post-procedural gastric amplitude and symptoms of heartburn, bloating, and weight loss identified.