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

BackgroundSleeve gastrectomy is an effective bariatric procedure, however 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, however, 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. MethodsPatients with previous sleeve gastrectomy underwent body surface gastric mapping (Gastric Alimetry, New Zealand), comprising 30-minute fasting baseline and 4-hr post-prandial recordings. Analysis encompassed Principal Gastric Frequency (PGF), BMI-adjusted amplitude, Gastric Alimetry Rhythm Index (GA-RI), with comparison to reference intervals and matched controls. Symptoms were evaluated using a validated App and questionnaires. Results38 patients (median 36 months post-surgery; range 6-119 months) and 38 controls were recruited. 35/38 patients had at least one abnormal parameter, typically reduced frequencies (2.3{+/-}0.34 vs controls 3.08{+/-}0.21; p<0.001) and amplitudes (14.8{+/-}6.9 vs 31.5{+/-}17.8; p<0.001). Patients exhibited higher symptoms and lower QoL (PAGI-SYM 20 vs controls 7, p<0.001; PAGI-QOL 27 vs 136, p<0.001). Gastric amplitude and GA-RI correlated positively with bloating (r=0.71, p<0.001 and r=0.60, p=0.02) while amplitude correlated negatively with heartburn (r=-0.46, p=0.03). Lower gastric amplitudes also correlated with greater weight loss (r=-0.45; p=0.014). ConclusionSleeve gastrectomy modifies gastric electrophysiology due to pacemaker resection, with variable remodelling. Substantial reductions in gastric frequency and amplitude occur routinely after surgery, and specific relationships between post-sleeve gastric amplitude, symptoms of heartburn and bloating, and weight loss are identified.