Wickremasinghe Anagi, Ferdinands Jessica, Johari Yazmin, Ho Patrick, Leang Yit, Yue Helen, Laurie Cheryl, Beech Paul, Nadebaum David P, Yap Kenneth S, Hebbard Geoffrey, Brown Wendy, Burton Paul
Department of Surgery, Central Clinical School, Monash University, Monash University, Melbourne, Australia.
Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia.
Obes Surg. 2024 Jan;34(1):150-162. doi: 10.1007/s11695-023-06951-2. Epub 2023 Nov 22.
Poor weight loss and weight regain are principal challenges following laparoscopic sleeve gastrectomy (LSG). There is a lack of standardised assessments and diagnostic tests to stratify the status post-LSG and determine whether anatomical or physiological problem exists. We aimed to compare nuclear scintigraphy gastric emptying with CT volumetric analysis of sleeve anatomy and determine the impact of anatomy on physiological function and its correlation with weight loss.
Patients greater than 12 months post-LSG were categorised into optimal weight loss (OWL) (n = 29) and poor weight loss groups (PWL) (n = 50). All patients underwent a protocolised nuclear scintigraphy and three-dimensional multi-detector computed tomography (3D-MDCT) gastric volumetry imaging.
Post-operative % total weight loss in OWL was 26.2 ± 10.5% vs. 14.2 ± 10.7% in the PWL group (p value < 0.0001). The PWL group had significantly more delayed gastric emptying half-time than OWL (34.1 ± 18.8 vs. 19.5 ± 4.7, p value < 0.0001). Gastric emptying half-time showed statistically significant correlations with weight loss parameters (BMI; r = 0.215, p value 0.048, %EWL; r = - 0.336, p value 0.002 and %TWL; r = - 0.379, p value < 0.001). The median gastric volume on 3D-MDCT did not differ between the OWL (246 (IQR 50) ml) and PWL group (262 (IQR 129.5) ml), p value 0.515. Nuclear scintigraphy gastric emptying half-time was the most highly discriminant measure. A threshold of 21.2 min distinguished OWL from PWL patients with 86.4% sensitivity and 68.4% specificity.
Nuclear scintigraphy is a potentially highly accurate tool in the functional assessment of sleeve gastrectomy physiology. It appears to perform better as a diagnostic test than volumetric assessment. Gastric volume did not correlate with weight loss outcomes. We have established diagnostic criteria of greater than 21 min to assess sleeve failure, which is linked to suboptimal weight loss outcomes.
腹腔镜袖状胃切除术（LSG）后体重减轻不佳和体重反弹是主要挑战。缺乏标准化评估和诊断测试来对LSG术后状态进行分层，并确定是否存在解剖或生理问题。我们旨在比较核素闪烁扫描法胃排空与袖状胃解剖结构的CT容积分析，并确定解剖结构对生理功能的影响及其与体重减轻的相关性。
LSG术后超过12个月的患者被分为最佳体重减轻组（OWL）（n = 29）和体重减轻不佳组（PWL）（n = 50）。所有患者均接受了标准化的核素闪烁扫描和三维多排计算机断层扫描（3D-MDCT）胃容积成像。
OWL组术后总体重减轻百分比为26.2±10.5%，而PWL组为14.2±10.7%（p值<0.0001）。PWL组胃排空半衰期明显比OWL组延迟（34.1±18.8 vs. 19.5±4.7，p值<0.0001）。胃排空半衰期与体重减轻参数（BMI；r = 0.215，p值0.048，%EWL；r = -0.336，p值0.002，%TWL；r = -0.379，p值<0.001）存在统计学显著相关性。3D-MDCT上的中位胃容积在OWL组（246（IQR 50）ml）和PWL组（262（IQR 129.5）ml）之间无差异，p值0.515。核素闪烁扫描法胃排空半衰期是最具鉴别力的指标。21.2分钟的阈值区分OWL和PWL患者的灵敏度为86.4%，特异度为68.4%。
核素闪烁扫描是评估袖状胃切除术生理功能的一种潜在高度准确的工具。作为诊断测试，它似乎比容积评估表现更好。胃容积与体重减轻结果无关。我们已建立大于21分钟的诊断标准来评估袖状胃手术失败，这与体重减轻效果不佳有关。
Zotero 插件