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Imaging the bariatric patient : employing conventional imaging techniques in unconventional ways

Klop, C. (2017) Imaging the bariatric patient : employing conventional imaging techniques in unconventional ways.

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Abstract:Introduction: A major complication after Roux-en-Y gastric bypass (RYGB) surgery is internal herniation. Computed tomography (CT) is the first line imaging technique. However, CT examination is often inadequate, which pleads for the development of alternatives. Besides internal herniation, insufficient weight loss and weight regain are significant adverse long-term outcomes. Currently, the exact influence of gastric pouch size and gastroenterostomy diameter on weight loss is unknown. Measurements of these anatomical structures can be performed using CT, but investigating upper gastrointestinal (UGI) series is an interesting possibility. Another challenge is diagnosing functional disorders in the bypassed part of the gastrointestinal tract, such as gastroparesis of the gastric remnant and stenosis of the biliopancreatic limb. At this time, no imaging techniques are capable of detecting such functional disorders. Methods: A clinical trial was performed to investigate CT angiography (CTA) for diagnosing internal herniation. Ten study subjects, clinically suspected for internal herniation, were subjected to venous phase CT arterial phase CTA examination. All subjects also underwent diagnostic laparoscopy, which served as gold standard. The CTA was used to create a 3D reconstruction of the mesenteric arteries and surgical staples (3D CTA). The 3D CTA was interpreted, taking into account the presence and type of internal hernia that was found upon laparoscopy. Results: 3D CTA studies of the subjects with active internal hernias demonstrated remarkable differences as compared to control 3D CTA studies. Particularly, the blood supply of herniated intestinal limbs showed abnormal courses. Furthermore, enteroenterostomy staple lines had migrated or altered orientation. Conclusion: 3D CTA is a promising technique for diagnosing active internal hernias. For diagnosing internal hernias, more effort should be directed towards the 3D assessment of the mesenteric vasculature and surgical staples. In general, quantitative measurements should become a key aspect in diagnostics of bariatric complications, instead of qualitative interpretations. Research proposals and preliminary research – UGI series is proposed for gastric pouch and gastroenterostomy size measurements. A phantom study was conducted to prove the feasibility of the proposed method, from which it was concluded that size estimations of a contrast-filled object by two biplanar X-ray images is feasible. A prospective study will be performed with twelve subjects. Size measurements using this newly developed technique will be compared to CT as gold standard. Furthermore, 99mTc pertechnetate nuclear imaging is proposed for evaluating the function of the gastric remnant and biliopancreatic limb. A prospective study will be conducted with twenty subjects.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine, 50 technical science in general
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/72773
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