• John Bennett, Michael Rhodes, Paul Malcolm, Jack Dainty, Ben Simpson, Ian Johnson, Alex Boddy, Martin Wickham, and Simon Williams.
• Department of Upper GI Surgery, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, NR4 7UY, Norwich, UK.
• Obes Surg. 2009 Jun 1;19(6):757-63.

BackgroundSwedish adjustable gastric banding (SAGB) is a common weight loss procedure performed worldwide. The exact mechanism by which it achieves appetite suppression, and hence weight loss, is not clear. One possible mechanism is altered meal handling by the post-SAGB stomach.MethodsFive post SAGB patients and five age/sex-matched controls were recruited. Pre- and post-meal magnetic resonance imaging (MRI) was performed with two liquid test meals of differing viscosity-locust bean gum (3.0%) and water. Appetite was assessed using ten-point visual analogue scales.ResultsThere were significant relationships between hunger scores and esophageal, pouch and residual stomach fluid volume changes for the locust bean gum meal (p=0.033, 0.043 and 0.011, respectively). The rate constants for gastric emptying were similar in the two groups for both the gum (0.038+/-0.016 min(-1) for SAGB, 0.041+/-0.032 min(-1) for controls, p=0.44) and water meals (0.068+/-0.044 min(-1) for SAGB, 0.044+/-0.009 min(-1) for controls, p=0.35). An unexpected finding was asymptomatic esophageal meal retention with the locust bean gum meal in the post-SAGB arm (mean 16.9 ml at 15 min).ConclusionsThere is no evidence of differences in volume-dependent gastric emptying between the normal and post-SAGB stomach. Further investigation of the phenomenon of esophageal retention, and its role in post-SAGB satiety, is warranted.

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