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HIDA and Seek: Challenges of Scintigraphy to Diagnose Bile Reflux Post-Bariatric Surgery.
Eldredge, Thomas A; Bills, Madison; Myers, Jennifer C; Bartholomeusz, Dylan; Kiroff, George K; Shenfine, Jonathan.
Afiliação
  • Eldredge TA; Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia. tom.andrew.eldredge@gmail.com.
  • Bills M; Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia. tom.andrew.eldredge@gmail.com.
  • Myers JC; Department of Nuclear Medicine, PET and Bone Densitometry, Royal Adelaide Hospital and SA Medical Imaging, Adelaide, South Australia, Australia.
  • Bartholomeusz D; Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia.
  • Kiroff GK; Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
  • Shenfine J; Department of Nuclear Medicine, PET and Bone Densitometry, Royal Adelaide Hospital and SA Medical Imaging, Adelaide, South Australia, Australia.
Obes Surg ; 30(5): 2038-2045, 2020 05.
Article em En | MEDLINE | ID: mdl-32133588
ABSTRACT

INTRODUCTION:

Oesophageal bile reflux after bariatric surgery may trigger development of Barrett's oesophagus. Gastro-oesophageal reflux of bile is captured by hepatobiliary iminodiacetic acid (HIDA) scintigraphy; however, anatomical and physiological changes after bariatric surgery warrant protocol modifications to optimise bile reflux detection.

METHODS:

HIDA scintigraphy occurred 6 months after either sleeve gastrectomy, Roux-en-Y gastric bypass or one-anastomosis gastric bypass. Standard HIDA scanning involves (i) 6-h fast and 24-h abstinence from opioids; (ii) IV administration of 99mTc di-isopropyl iminodiacetic acid; and (iii) dual anterior/posterior 60-min dynamic scanning of the duodenum, stomach and oesophagus. Three challenges were identified, and modifications were implemented, namely, (1) anatomical localisation of refluxed bile on planar scintigraphy was improved by adding a SPECT/CT for 3D imaging; (2) impaired cholecystokinin-controlled gallbladder emptying, following bypassed duodenum, was addressed by ingestion of a 'fatty meal'; and (3) intestinal hypomotility after gastric bypass was counteracted by longer scan duration (75-90 min) to allow bile to pass beyond the gastro-jejunal anastomosis.

RESULTS:

HIDA scan was undertaken in 18 patients, 13 of whom underwent the modified protocol. The tailored protocol ameliorated issues identified with the standard HIDA scan protocol; thus, accurate anatomical localisation was achieved in all patients, no delayed gallbladder emptying was observed, and bile was observed beyond the gastro-jejunal anastomosis in all gastric bypass patients. The modified technique was well tolerated by patients.

CONCLUSION:

A tailored HIDA scan protocol with addition of a SPECT-CT scan, ingestion of a fatty meal and prolonged scanning duration results in enhanced bile reflux detection in post-bariatric surgical patients.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Obesidade Mórbida / Refluxo Biliar / Cirurgia Bariátrica Tipo de estudo: Diagnostic_studies / Etiology_studies Limite: Humans Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Obesidade Mórbida / Refluxo Biliar / Cirurgia Bariátrica Tipo de estudo: Diagnostic_studies / Etiology_studies Limite: Humans Idioma: En Ano de publicação: 2020 Tipo de documento: Article