Computed tomography-3D-volumetry: a valuable adjunctive diagnostic tool after bariatric surgery

Abstract

Aim: After bariatric surgery, a variety of complaints may arise. Identification of the causes of such symptoms is often challenging due to the postoperatively modified anatomy. While standard examinations with upper endoscopy and upper gastrointestinal series might miss the three-dimensional anatomic nature of the problem, quantitative three-dimensional computed tomography volumetry (3D-CT) of the upper gastrointestinal tract offers a novel, adjunctive examination, revealing the detailed anatomy. The aim of this study was to analyse the clinical value of 3D-CT in post-bariatric patients.

Methods: Prospective data of 279 patients, who underwent 3D-CT due to complications after different bariatric procedures, were retrospectively analysed. Directly before examination, the surgical-modified stomach was distended with an effervescent-powder. CT images were 3D-reconstructed and, further, gastric volume was calculated.

Results: In total, 279 patients were examined. Time between surgery and examination was significantly different between Roux-en-Y gastric bypass (n = 168) (54.3 ± 38.6 months) and sleeve gastrectomy (n = 78) (27.8 ± 21.7 months) (P = 0.0001). Others, less numerous, but included procedures were one-anastomosis/mini gastric bypass (n = 11), and dated procedures, such as the vertical banded gastrostomy. The examination allowed calculation of the gastric volume, and the 3D-reconstructions depicted accurately the pivotable anatomic details of the modified upper gastrointestinal tract with 360° view. As a robust result, patients with a higher gastric volume showed more weight regain after sleeve gastrectomy.

Conclusion: 3D-CT is easy-to-perform and facilitates identification of the post-surgical three-dimensional gastric anatomy. It represents a valuable additional diagnostic tool in post-bariatric patients with post-procedural complications. 3D-CT might be an important preoperative tool prior to revisional surgery. In addition, this is the only exact and reproducible calculation of the gastric volume.

Keywords

Gastrointestinal tract / computed tomography / gastric volumetry / 3D-reconstruction / anatomical accuracy

References

[1] Sjöström L,Peltonen M,Bouchard C.Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardio- vascular risk factors 10 years after bariatric surgery..N Engl J Med2004;351:2683-93

[2] Schauer PR,Kirwan JP,Aminian A.Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes..N Engl J Med2017;376:641-51 PMCID:PMC5451258

[3] Mingrone G,De Gaetano A,Iaconelli A.Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial..Lancet2015;386:964-73

[4] Healy P,Reynolds I,McNamara D.Complications of bariatric surgery--What the general surgeon needs to know..Surgeon2016;14:91-8

[5] Livingston EH.Complications of bariatric surgery..Surg Clin North Am2005;85:853-68

[6] Abd Ellatif ME,Asker WA,Magdy A.Place of upper endoscopy before and after bariatric surgery: a multicenter experience with 3219 patients..World J Gastrointest Endosc2016;8:409-17 PMCID:PMC4877533

[7] Brethauer SA,Sherman V,Schauer PR.Endoscopy and upper gastrointestinal contrast studies are complementary in evaluation of weight regain after bariatric surgery..Surg Obes Relat Dis2006;2:643-8

[8] Nagpal P,Pradhan G,Nagpal N.MDCT imaging of the stomach: advances and applications..Br J Radiol2017;90:20160412 PMCID:PMC5605014

[9] Hanssen A,Acosta G,Haddad J.3D volumetry and its correlation between postoperative gastric volume and excess weight loss after sleeve gastrectomy..Obes Surg2018;28:775-80

[10] Robert M,Marion D,Gouillat C.Relevance of Roux-en-Y gastric bypass volumetry using 3-dimensional gastric computed tomography with gas to predict weight loss at 1 year..Surg Obes Relat Dis2015;11:26-31

[11] Blanchet MC,Yanes M,Marion D.3D gastric computed tomography as a new imaging in patients with failure or complication after bariatric surgery..Obes Surg2010;20:1727-33

[12] Kawamoto S.Adjustable laparoscopic gastric banding: Demonstrated on mutlidetector computed tomography with multiplanar reformation and 3-dimensional imaging..J Comput Assist Tomogr2009;33:288-90

[13] Karcz WK,Marjanovic G,Kotter E.3D-MSCT gastric pouch volumetry in bariatric surgery - preliminary clinical results..Obes Surg2009;19:508-16

[14] Baumann T,Pache G,Marjanovic G.Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration..Surg Endosc2011;25:2323-9

[15] Stier C.Endoluminal revision (OverStitch (TM), apollo endosurgery) of the dilated gastroenterostomy in patients with late dumping syndrome after proximal roux-en-Y gastric bypass..Obes Surg2016;26:1978-84