The impact of delayed gastric emptying as measured by gastric emptying scintigraphy on the outcome of magnetic sphincter augmentation

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.

Keywords: Bloating; Delated gastric emptying; Gastroparesis; Magnetic sphincter augmentation; Outcome.

Fig. 1

Mean GERD-HRQL total scores for normal and delayed gastric emptying groups at 6-month, 1-year and 2-year follow-up are shown with standard error bars. Delayed emptying was associated with a lower 6-month total score (p = 0.0013)

Fig. 2

GERD-HRQL symptom-specific item scores ≥ 4 at 6-month, 1-year and 2-year follow-up are shown for patients who had delayed gastric emptying. The percent of patients who scored the gas-bloat item ≥ 4 significantly decreased between 6 months and 1 year (p = 0.004). No other changes in symptoms reached significance (p > 0.05)

Fig. 3

A Correlation between GERD-HRQL total score at 6 months and preoperative 4-h percent retention on gastric emptying scintigraphy (R = 0.253, p = 0.039). Correlation between (B) GERD-HRQL Heartburn item score at 6 months (R = 0.242, p = 0.048) and C GERD-HRQL Gas-bloat item score at 6 months (R = 0.246, p = 0.045) with preoperative 4 h percent retention on gastric emptying scintigraphy