Fluoroscopic examination of stomach shapes after sleeve gastrectomy: Implications for long-term weight loss and esophagitis

Fluoroscopic examination of stomach shapes after sleeve gastrectomy: Implications for long-term weight loss and esophagitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Fluoroscopic examination of stomach shapes after sleeve gastrectomy: Implications for long-term weight loss and esophagitis Kotaro Wakamatsu, Taiki Nabekura, Natsumi Kitahara, Yuuki Moriyama, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6435338/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Stomach morphology influences laparoscopic sleeve gastrectomy (LSG) outcomes, including weight loss and gastroesophageal reflux. This study examined the impact of stomach shape on long-term weight loss and esophagitis post-LSG. Methods: We analyzed 162 patients who underwent LSG. Stomach shape was categorized into three subgroups based on postoperative fluoroscopy contrast pooling: upper and lower portions (ULP), lower portion (LP), and smooth flow (SF) postoperatively. Short-term operative outcomes, surgical procedures, five-year weight loss, and esophagitis, diagnosed by upper endoscopy using the L A classifications, were compared across groups. Results: The stomach shape distribution was ULP (12%), LP (29%), and SF (59%)). Operative outcomes were generally comparable; however, ULP tended to exhibit smaller bougie sizes (ULP: 31.8±9.7 vs. LP: 34.3±6.4 vs. SF: 34.4±6.3 cm). Preoperative assessments revealed no Grade C esophagitis, with most patients exhibiting normal findings. Post-LSG clinical changes were comparable, although de novo esophagitis was more frequent in the SF shape (ULP vs. LP vs. SF, de novo/improved/persistent/worsened, 10%/ 0% 84%/ 6% vs. 21%/ 0% 72% 6% vs. 31%/ 4%/ 60%/4%, respectively; p=0.24). Weight loss after LSG was compared, and no significant differences were observed among the groups; however, LP tended to maintain total weight loss (TWL) at 5 years (TWL%: ULP vs. LP vs. SF; 21.3±3.9 vs. 23.1±7.4 vs. 21.5 ±8.8 %, respectively; p=0.859). Conclusion: Patients with SF had the highest de novo esophagitis incidence. The LP shape was linked with sustained long-term weight loss. Therefore, creating an LP shape should be the optimal surgical objective. Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6435338","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":453283180,"identity":"cb778b88-05fc-4820-a5e8-6fbb3a48bd45","order_by":0,"name":"Kotaro Wakamatsu","email":"","orcid":"","institution":"Toho University","correspondingAuthor":false,"prefix":"","firstName":"Kotaro","middleName":"","lastName":"Wakamatsu","suffix":""},{"id":453283181,"identity":"bdf58bb9-9288-401d-a26a-499bbf9c15c4","order_by":1,"name":"Taiki Nabekura","email":"data:image/png;base64,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","orcid":"","institution":"Toho University","correspondingAuthor":true,"prefix":"","firstName":"Taiki","middleName":"","lastName":"Nabekura","suffix":""},{"id":453283183,"identity":"886ad3f3-b644-4618-876d-58f108ad66c9","order_by":2,"name":"Natsumi Kitahara","email":"","orcid":"","institution":"Toho University","correspondingAuthor":false,"prefix":"","firstName":"Natsumi","middleName":"","lastName":"Kitahara","suffix":""},{"id":453283184,"identity":"72c5ce71-d855-48ab-aba8-ae1c686ba765","order_by":3,"name":"Yuuki Moriyama","email":"","orcid":"","institution":"Toho University","correspondingAuthor":false,"prefix":"","firstName":"Yuuki","middleName":"","lastName":"Moriyama","suffix":""},{"id":453283186,"identity":"851a5183-838b-4b67-95be-356edd4f393c","order_by":4,"name":"Takashi Oshiro","email":"","orcid":"","institution":"Jikei University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Takashi","middleName":"","lastName":"Oshiro","suffix":""}],"badges":[],"createdAt":"2025-04-12 15:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6435338/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6435338/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87637698,"identity":"95e19fc1-6158-443a-ac4d-b33409254731","added_by":"auto","created_at":"2025-07-26 12:46:37","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":501763,"visible":true,"origin":"","legend":"","description":"","filename":"SGmorphologyDraft20250416Submit.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6435338/v1_covered_2898dadb-bc43-406c-8193-4f7d2f49a5fd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFluoroscopic examination of stomach shapes after sleeve gastrectomy: Implications for long-term weight loss and esophagitis\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6435338/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6435338/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction: Stomach morphology influences laparoscopic sleeve gastrectomy (LSG) outcomes, including weight loss and gastroesophageal reflux. This study examined the impact of stomach shape on long-term weight loss and esophagitis post-LSG.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: We analyzed 162 patients who underwent LSG. Stomach shape was categorized into three subgroups based on postoperative fluoroscopy contrast pooling: upper and lower portions (ULP), lower portion (LP), and smooth flow (SF) postoperatively. Short-term operative outcomes, surgical procedures, five-year weight loss, and esophagitis, diagnosed by upper endoscopy using the L A classifications, were compared across groups.\u003c/p\u003e\n\u003cp\u003eResults: The stomach shape distribution was ULP (12%), LP (29%), and SF (59%)). Operative outcomes were generally comparable; however, ULP tended to exhibit smaller bougie sizes (ULP: 31.8±9.7 vs. LP: 34.3±6.4 vs. SF: 34.4±6.3 cm).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePreoperative assessments revealed no Grade C esophagitis, with most patients exhibiting normal findings. Post-LSG clinical changes were comparable, although de novo esophagitis was more frequent in the SF shape (ULP vs. LP vs. SF, de novo/improved/persistent/worsened, 10%/ 0% 84%/ 6% vs. 21%/ 0% 72% 6% vs. 31%/ 4%/ 60%/4%, respectively; p=0.24). Weight loss after LSG was compared, and no significant differences were observed among the groups; however, LP tended to maintain total weight loss (TWL) at 5 years (TWL%: ULP vs. LP vs. SF; 21.3±3.9 vs. 23.1±7.4 vs. 21.5 ±8.8 %, respectively; p=0.859).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: Patients with SF had the highest de novo esophagitis incidence. The LP shape was linked with sustained long-term weight loss. 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