A new modality to evaluate the gastric remnant after Roux-en-Y gastric bypass
Received 11 May 2007; received in revised form 19 July 2007; accepted 6 September 2007. published online 02 November 2007.
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.
Department of Surgery, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
Reprint requests: Robert Bell, M.D., M.A., F.A.C.S., Director of Bariatric Surgery, Assistant Professor, Department of Surgery, Yale University School of Medicine, 40 Temple St., Suite 7B, New Haven, CT 06510.
ABSTRACT