title: Association of radiographic morphology with early gastroesophageal reflux disease and satiety control after sleeve gastrectomy.
abstract: BACKGROUND
  Variable gastric morphology has been identified on routine upper gastrointestinal series after laparoscopic sleeve gastrectomy. This test might give us useful information beyond the presence of leak and obstruction. The aim of this study is to standardize a morphologic classification of gastric sleeve based on water-soluble contrast upper gastrointestinal series, and to determine possible clinical implications.
  
  
  METHODS
  One hundred morbidly obese patients underwent laparoscopic sleeve gastrectomy and had routine upper gastrointestinal on postoperative day 1 or 2. Images were reviewed by 4 radiologists who were blinded to outcomes, and sleeve shape was classified as upper pouch, lower pouch, tubular, or dumbbell. Inter-observer agreement was calculated. Clinical outcomes including weight loss, satiety control, and reflux symptoms were recorded. Comparisons were determined by 1-way ANOVA and t-test.
  
  
  RESULTS
  Mean age was 46 ± 12 years and mean BMI was 45.1 ± 6 kg/m(2). Overall inter-observer agreement level for the sleeve shape classification was 76.3%. Sleeve shapes were tubular in 37%, dumbbell in 32%, lower pouch in 22%, and upper pouch in 8%. Mean excess body weight loss at 1, 3, and 6 months was 16.8%, 29.9%, and 39.1%, respectively. Excess body weight loss was not associated with sleeve shape. Mean hunger score was 213 ± 97, and patients with dumbbell shape had higher hunger scores (p = 0.003). Mean reflux score was 5.7 ± 8. Upper pouch shape was associated with greater severity of reflux symptoms (p = 0.02).
  
  
  CONCLUSIONS
  This study suggests a standardized radiographic classification of gastric sleeve morphology. Although sleeve shape is not correlated with weight loss, gastric sleeves with retained fundus result in lower satiety control and higher severity of reflux symptoms. An adequate resection of the gastric fundus might avoid this potential complication.
authors.affiliation: Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Toro
authors.affiliation: Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA. Electronic address: elin2@emory.edu.
authors.forename: Edward
authors.initials: E
authors.lastname: Lin
authors.affiliation: Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA.
authors.forename: Ankit D
authors.initials: AD
authors.lastname: Patel
authors.affiliation: Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA.
authors.forename: S Scott
authors.initials: SS
authors.lastname: Davis
authors.affiliation: Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA.
authors.forename: Aliu
authors.initials: A
authors.lastname: Sanni
authors.affiliation: Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA.
authors.forename: Hernan D
authors.initials: HD
authors.lastname: Urrego
authors.affiliation: Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA.
authors.forename: John F
authors.initials: JF
authors.lastname: Sweeney
authors.affiliation: Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA.
authors.forename: Jahnavi K
authors.initials: JK
authors.lastname: Srinivasan
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
authors.forename: William
authors.initials: W
authors.lastname: Small
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
authors.forename: Pardeep
authors.initials: P
authors.lastname: Mittal
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
authors.forename: Aarti
authors.initials: A
authors.lastname: Sekhar
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
authors.forename: Courtney C
authors.initials: CC
authors.lastname: Moreno
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000145:classification* / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011859:Radiography; D012527:Satiation; D055815:Young Adult