Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia.
Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
Obes Surg. 2020 May;30(5):2038-2045. doi: 10.1007/s11695-020-04510-7.
Oesophageal bile reflux after bariatric surgery may trigger development of Barrett's oesophagus. Gastro-oesophageal reflux of bile is captured by hepatobiliary iminodiacetic acid (HIDA) scintigraphy; however, anatomical and physiological changes after bariatric surgery warrant protocol modifications to optimise bile reflux detection.
HIDA scintigraphy occurred 6 months after either sleeve gastrectomy, Roux-en-Y gastric bypass or one-anastomosis gastric bypass. Standard HIDA scanning involves (i) 6-h fast and 24-h abstinence from opioids; (ii) IV administration of 99mTc di-isopropyl iminodiacetic acid; and (iii) dual anterior/posterior 60-min dynamic scanning of the duodenum, stomach and oesophagus. Three challenges were identified, and modifications were implemented, namely, (1) anatomical localisation of refluxed bile on planar scintigraphy was improved by adding a SPECT/CT for 3D imaging; (2) impaired cholecystokinin-controlled gallbladder emptying, following bypassed duodenum, was addressed by ingestion of a 'fatty meal'; and (3) intestinal hypomotility after gastric bypass was counteracted by longer scan duration (75-90 min) to allow bile to pass beyond the gastro-jejunal anastomosis.
HIDA scan was undertaken in 18 patients, 13 of whom underwent the modified protocol. The tailored protocol ameliorated issues identified with the standard HIDA scan protocol; thus, accurate anatomical localisation was achieved in all patients, no delayed gallbladder emptying was observed, and bile was observed beyond the gastro-jejunal anastomosis in all gastric bypass patients. The modified technique was well tolerated by patients.
A tailored HIDA scan protocol with addition of a SPECT-CT scan, ingestion of a fatty meal and prolonged scanning duration results in enhanced bile reflux detection in post-bariatric surgical patients.
减重手术后的食管胆汁反流可能引发 Barrett 食管。肝胆碘代氨基酸（HIDA）闪烁显像术可捕捉到胃食管胆汁反流；然而，减重手术后的解剖和生理变化需要对方案进行修改，以优化胆汁反流的检测。
在袖状胃切除术、Roux-en-Y 胃旁路术或单吻合口胃旁路术后 6 个月进行 HIDA 闪烁显像术。标准 HIDA 扫描包括：（i）6 小时禁食和 24 小时戒断阿片类药物；（ii）静脉注射 99mTc 二异丙基亚氨基二乙酸；（iii）十二指肠、胃和食管的双前/后 60 分钟动态扫描。确定了三个挑战，并进行了修改，即：（1）通过添加 SPECT/CT 进行 3D 成像，改善了平面闪烁显像术上反流胆汁的解剖定位；（2）通过摄入“高脂肪餐”解决了绕过的十二指肠导致的胆囊收缩素控制的胆囊排空受损问题；（3）胃旁路术后肠动力不足，通过延长扫描时间（75-90 分钟）来对抗，使胆汁通过胃空肠吻合口。
18 例患者接受了 HIDA 扫描，其中 13 例患者接受了改良方案。该方案改善了标准 HIDA 扫描方案中存在的问题；因此，所有患者均实现了准确的解剖定位，未观察到胆囊排空延迟，所有胃旁路术患者的胆汁均在胃空肠吻合口之外观察到。改良技术得到了患者的良好耐受。
通过添加 SPECT-CT 扫描、摄入高脂肪餐和延长扫描时间，对 HIDA 扫描方案进行了改良，从而提高了减重手术后患者的胆汁反流检测率。
