Gastric Emptying in Patients with Laparoscopic Banding

We had a patient referred for a gastric emptying study following laparoscopic banding. The questions that came up were: Where should we put the region-of-interest and What values would count as normal.

Tiktinsky et al, studied gastric emptying in 16 asymptomatic patients following laparoscopic banding by placing their region-of-interest around the gastric pouch and around the whole stomach. They report values for the gastric pouch. Hladik et al studied gastric emptying in 6 patients prior to and following laparoscopic banding, but don't specify where their region-of-interest was placed.

Regarding the second question, Hladik et al, using a solid meal, found an average T_1/2 of 24 minutes or so for obese patients pre-operatively. Post-operative patients who had good weight loss had delayed gastric emptying with T_1/2 of 53 minutes. Patients who didn't have significant reduction in body weight, on the other hand, didn't show prolonged gastric emptying times.

Tiktinsky et al used semi-solid meals and found a T_1/2 of about 37 minutes in postoperative patients, compared to 23 minutes or so for a different group of obese patients prior to surgery.

So it seems that the region-of-interest should be placed around the gastric pouch and that prolonged emptying with T_1/2 of 50 minutes or so should be expected for solid meals in patients with good weight loss, and about 20 or so for those without significant weight loss. Tiktinsky et al's study was not longitudinal, but their study suggests that a T_1/2 of about 40 minutes should be expected in asymptomatic patients using a semi-solid meal.

We ended up putting regions-of-interest around the gastric pouch and the total stomach. The T_1/2 values for the two were nearly the same (about 40).

References

• Hladik P, Vizda J, Mala E, Zadak Z, Hroch T. The contribution of gastric emptying scintigraphy to the treatment of obesity with gastric bandage--preliminary results. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2008 Jun;152(1):125-8.
• Tiktinsky E, Lantsberg L, Lantsberg S, Mizrahi S, Agranotvich S, Friger M, Kirshtein B. Gastric emptying of semisolids and pouch motility following laparoscopic adjustable gastric banding. Obes Surg. 2009 Sep;19(9):1270-3.