TIME-DEPENDENT RECOVERY OF GASTRIC EMPTYING AFTER GASTRECTOMY: A 12-MONTH LONGITUDINAL STUDY USING A 13C-ACETATE BREATH TEST WITH A SEMI-SOLID MEAL
Sachiko Kaida1, Katsushi Takebayashi2, 1, Asuka Fukuo1, Reiko Otake1, Keiji Muramoto1, Nobuhito Nitta1, Soichiro Tani1, Haruki Mori1, Masatsugu Kojima1, Hiromitsu Maehira1, Toru Miyake1, Mika Kurihara2, Shigeki Bamba3, Masaji Tani11. Surgery, Shiga Ika Daigaku, Otsu, Shiga Prefecture, Japan.
2. Division of Clinical Nutrition, Shiga University of Medical Science, Otsu, Japan.
3. Department of Fundamental Nursing, Shiga University of Medical Science, Otsu, Japan.
Aims:
Gastric emptying dysfunction is a major concern after gastrectomy for gastric cancer, affecting nutrition and quality of life. However, its long-term course and relation to surgical procedures remain unclear. This study aimed to evaluate time-dependent recovery of gastric emptying function over 12 months using the 13C-acetate breath test with a semi-solid meal.
Methods:
A prospective cohort of 95 patients who underwent curative gastrectomy between April 2021 and July 2024 was analyzed. Gastric emptying was assessed preoperatively and at 1, 6, and 12 months postoperatively using a 13C-acetate breath test with a standardized semi-solid meal (Figure 1). The gastric emptying half-time (T1/2) was compared among surgical types (distal, proximal, total) and reconstruction methods (Billroth I, Roux-en-Y, modified side-overlap esophagogastrostomy [mSOFY] (Figure 2a, b, c)). Associations between T1/2 and postoperative nutritional parameters were also examined.
Results:
The median T1/2 was 42.0 min preoperatively, delayed to 45.9 min at 1 month, and then decreased to 23.4 and 18.7 min at 6 and 12 months, respectively, indicating an early delay followed by acceleration. In distal gastrectomy, especially Billroth I and Roux-en-Y, T1/2 was prolonged at 1 month but improved markedly by 12 months. Proximal gastrectomy with mSOFY and total gastrectomy showed persistently rapid emptying, reflecting early loss of reservoir function. Patients with rapid emptying often experienced transient weight loss and early satiety, whereas delayed emptying was associated with dyspeptic symptoms. Reconstruction type and remnant stomach volume independently predicted postoperative T1/2 recovery (p<0.05).
Discussion:
This study demonstrated continuous postoperative adaptation of gastric motility. Early delay likely results from transient inflammation and vagal disturbance, whereas subsequent acceleration reflects compensatory intestinal motility and reduced gastric compliance. The persistent rapid emptying after proximal or total gastrectomy highlights physiologic loss of fundic accommodation, while gradual normalization after distal gastrectomy indicates adaptation of the remnant stomach. These findings underscore the need for time- and procedure-specific nutritional care, including staged diet progression and use of prokinetics during early recovery. The semi-solid 13C-acetate breath test provided a reproducible and noninvasive tool for monitoring postoperative function.
Conclusion:
Gastric emptying after gastrectomy changes dynamically within one year, showing early delay and later acceleration. The degree of change differs by surgical type and reconstruction method. Understanding these time-dependent patterns supports individualized nutritional strategies to improve recovery and quality of life in gastric cancer patients.
Back to 2026 Abstracts