Journal article
The impact of delayed gastric emptying as measured by gastric emptying scintigraphy on the outcome of magnetic sphincter augmentation
Surgical endoscopy, v 37(9), pp 7144-7152
01 Sep 2023
PMID: 37328595
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Introduction
The impact of delayed gastric emptying (DGE) on the outcome of anti-reflux surgery (ARS) is controversial. There is concern that poor gastric emptying diminishes outcomes. Magnetic sphincter augmentation (MSA) may have a comparatively mild impact on gastric physiology, but the relationship between DGE and MSA outcomes is unknown. This study aims to evaluate the relationship between objective DGE and MSA outcomes over time.
Methods
Patients who completed gastric emptying scintigraphy (GES) prior to MSA between 2013 and 2021 were included. DGE was defined as a 4 h retention > 10% or half emptying time > 90 min on GES. Outcomes were compared between DGE and normal gastric emptying (NGE) groups at 6 months, 1 and 2 years. Sub-analysis of patients with severe (> 35%) DGE and correlation analysis between 4-h retention and symptom and acid-normalization were performed.
Results
The study population consisted of 26 (19.8%) patients with DGE and 105 with NGE. DGE was associated with more 90-days readmissions (18.5 vs 2.9%,
p
= 0.009).
At 6 months patients with DGE had higher median (IQR) GERD-HRQL total [17.0(10–29) vs 5.5(3–16),
p
= 0.0013], heartburn [1(1–3) vs 0(0–1),
p
= 0.0010) and gas-bloat [4(2–5) vs 2(1–3),
p
= 0.033] scores.
Outcomes at 1 and 2 years follow-up were comparable (
p
> 0.05). From 6 months to 1-year the gas-bloat score decreased from 4(2–5
)
to 3(1–3),
p
= 0.041. Total and heartburn scores decreased, but not significantly.
Severe DGE (
n
= 4) patients had lower antiacid medication freedom at 6 months (75 vs 87%,
p
= 0.014) and 1-year (50 vs 92%,
p
= 0.046). There were non-significant trends for higher GERD-HRQL scores, dissatisfaction, and removal rates in severe DGE at 6 months and 1-year.
There was a weak correlation between 4-h retention and 6-month GERD-HRQL total score [
R
= 0.253, 95%CI (0.09–0.41),
p
= 0.039], but not acid-normalization (
p
> 0.05).
Conclusion
Outcomes after MSA are diminished early on in patients with mild-to-moderate DGE, but comparable by 1 year and durable at 2 years. Severe DGE outcomes may be suboptimal.
Graphical abstract
Metrics
Details
- Title
- The impact of delayed gastric emptying as measured by gastric emptying scintigraphy on the outcome of magnetic sphincter augmentation
- Creators
- Sven E. Eriksson - Allegheny Health NetworkPing Zheng - Allegheny Health NetworkInanc S. Sarici - Allegheny Health NetworkXinxin Shen - Allegheny Health NetworkBlair A. Jobe - Allegheny Health NetworkShahin Ayazi - Allegheny Health Network
- Publication Details
- Surgical endoscopy, v 37(9), pp 7144-7152
- Publisher
- Springer US
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:001012134200002
- Scopus ID
- 2-s2.0-85161990785
- Other Identifier
- 991021887634704721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Surgery