腹部计算机断层扫描对 Roux-en-Y 胃旁路术后胃-胃吻合口瘘的诊断价值。
Test Characteristics of Abdominal Computed Tomography for the Diagnosis of Gastro-gastric Fistula in Patients with Roux-en-Y Gastric Bypass.
机构信息
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, 02115, USA.
出版信息
Obes Surg. 2021 Jun;31(6):2471-2476. doi: 10.1007/s11695-021-05296-y. Epub 2021 Feb 22.
INTRODUCTION
Gastrogastric fistulae (GGF) occur in 1-6% of Roux-en-Y gastric bypass (RYGB) patients. Many patients undergo abdominal computed tomography (CT) as an initial test owing to its wide availability; however, CT diagnostic accuracy for GGF is unclear. Our aim was to evaluate test characteristics of abdominal CT compared to upper gastrointestinal series (UGI) and esophagogastroduodenoscopy (EGD) for diagnosing GGF using surgery as a gold standard.
METHODS
Retrospective review of RYGB patients who underwent abdominal CT with oral contrast within 1 year. Demographics, weight parameters, and symptoms were collected. Surgery within 1 year of the diagnostic tests was included as the gold standard comparison. Primary outcomes included CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) for GGF.
RESULTS
One hundred thirty-seven patients were included, where 42 (30.1%) had positive CT and 95 (69.3%) had negative CT for GGF. Compared to surgical confirmation, CT abdomen with PO contrast had sensitivity of 73.1% (59-84.4), specificity of 95.2% (88.3-98.7), PPV 90.5% (77.4-97.3), NPV of 85.1% (76.3-91.2), and DA 89.7%. UGI series had sensitivity of 58.5% (42.1-73.7), specificity of 98.8% (93.5-99.9), PPV of 96% (79.7-99.9), NPV of 82.8% (73.9-89.7), and diagnostic accuracy (DA) of 85.4%. EGD had sensitivity of 78.3% (63.6-89.1), specificity of 98.8% (93.5-99.9), PPV 97.3 (85.8-99.9), and DA 91.5%. There were no significant differences in diagnostic test characteristics among modalities.
CONCLUSIONS
Abdominal CT with oral contrast has similar diagnostic test characteristics to UGI and EGD at detecting GGF when using surgical diagnosis as a gold standard.
简介
胃胃瘘（Gastrogastric fistulae，GGF）在 Roux-en-Y 胃旁路术（RYGB）患者中的发生率为 1%-6%。由于腹部计算机断层扫描（CT）广泛应用，许多患者首先进行该检查；然而，CT 对 GGF 的诊断准确性尚不清楚。本研究旨在评估腹部 CT 相对于上消化道造影（UGI）和食管胃十二指肠镜（EGD）在以手术为金标准诊断 GGF 时的检测特征。
方法
回顾性分析了 1 年内接受口服造影剂腹部 CT 检查的 RYGB 患者。收集了患者的人口统计学、体重参数和症状。将诊断性检查后 1 年内的手术作为金标准比较。主要结局包括 GGF 的 CT 敏感度、特异度、阳性预测值（Positive Predictive Value，PPV）、阴性预测值（Negative Predictive Value，NPV）和诊断准确性（Diagnostic Accuracy，DA）。
结果
共纳入 137 例患者，其中 42 例（30.1%）CT 阳性，95 例（69.3%）CT 阴性。与手术结果比较，腹部 CT 平扫加口服造影剂检查的敏感度为 73.1%（59%-84.4%），特异度为 95.2%（88.3%-98.7%），PPV 为 90.5%（77.4%-97.3%），NPV 为 85.1%（76.3%-91.2%），DA 为 89.7%。上消化道造影的敏感度为 58.5%（42.1%-73.7%），特异度为 98.8%（93.5%-99.9%），PPV 为 96%（79.7%-99.9%），NPV 为 82.8%（73.9%-89.7%），DA 为 85.4%。食管胃十二指肠镜检查的敏感度为 78.3%（63.6%-89.1%），特异度为 98.8%（93.5%-99.9%），PPV 为 97.3%（85.8%-99.9%），DA 为 91.5%。各检测方法的诊断检测特征无显著差异。
结论
以手术诊断为金标准时，口服造影剂腹部 CT 与上消化道造影和食管胃十二指肠镜检查在检测 GGF 方面具有相似的诊断检测特征。
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