A new modality to evaluate the gastric remnant after Roux-en-Y gastric bypass

Abstract 

Background

Gastric bypass surgery has become one of the most common operations performed in the United States. Exclusion of the gastric remnant has raised concerns about the difficulty for future evaluation of mucosal-based lesions. Current methods include retrograde endoscopy, which is technically challenging, or a surgically created gastrotomy. Both procedures are invasive. Virtual colonoscopy is becoming an accepted means of colonic mucosal evaluation. Hence, we used virtual three-dimensional computed tomograpy (3D-CT), also referred to as virtual gastroscopy, to evaluate the gastric mucosa in patients who have undergone laparoscopic Roux-en-Y gastric bypass (LRYGB).

Methods

After institutional review board approval, 3 patients who had undergone LRYGB were consented for evaluation. Virtual gastroscopy was performed using a 16-channel multidetector CT scan, and 3D images were rendered using proprietary software (Vital Images, Inc.).

Results

Endoluminal views of the gastric remnant were generated using perspective volume rendering. Virtual fly-through images were obtained by manipulating data acquired from the 3D-CT. Out of the 3 patients evaluated, we were able to achieve remnant gastric distension in 2 patients with no adverse effects.

Conclusion

This is the first report of performing virtual gastroscopy to evaluate the remnant stomach after LRYGB. Variations of this technique may minimize the need for invasive and technically challenging studies in this patient population.

Keywords: Remnant stomach, Imaging, Gastric bypass