The Usefulness of Levin Tube Inserted Drip Infusion Spiral CT: Comparison with Conventional Method in SubtotalGastrectomy Patients

ABSTRACT

PURPOSE: To access the usefulness of newly designed Leven tube inserted drip infusion spiral CT for theevaluation of remnant stomach and anastomosis site in patients who have undergone subtotal gastrectomy for stomachcancer. MATERIAL AND METHODS: A new technique named Levin tube inserted drip infusion spiral CT was used toprospectively study 23 patients. A 16Fr Levin tube was inserted into the remnant stomach ; 500ml of tap water wasdrip infused just before CT scanning and an additional 500ml of water was infused during IV contrast injection.Water was infused by gravity, using a water bottle suspended at a height of 90cm(Group A). The 31 patients whounderwent conventional spiral CT scanning immediately after the divided ingestion of 900ml diluted gastrografinwere selected as a control group(Group B). The anatomic delineation of the anastomosis site was graded by tworadiologists as excellent(3), good(2), fair(1) or poor(0). To evaluate the degree of distension, the maximaldiameters of remnant stomach and the anastomosis site, and the thickness of the stomach wall, were also measured. RESULTS: In group A, anatomic delineation of the anastomosis site was excellent, compared to group B(mean score:2.91 vs 1.19, P<0.01). In addition, the maximum diameters of remnant stomach and anastomosis site weresignificantly larger in group A than in group B(transverse A-P remnant stomach and anastomosis site : 92.4+/-16.0mm, 97.6+/-26.5mm, 29.7+/-7.3mm vs 50.6+/-12.9mm, 53.5+/-14.4mm, 7.7+/-4.4mm, P<0.01). The mean thickness of distended stomach wallin group A was 3.2+/-1.7mm ; in group B, measurement was possible in only a few cases, but their number was too smallfor comparison. CONCLUSION: In patients who had undergone subtobal gastrectomy, Levin tube inserted drip infusionspiral CT showed excellent anatomic delineation of the site of anastomosis and remnant stomach. We found thatbecause it increases the distension of remnant stomach and the anastomosis site, this technique is effective forthe evaluation of postoperative stomach.