Stomach Volume Assessment Using Three-dimensional Computed Tomography Gastrography for Bariatric Treatment

Three-Dimensional Multi-detector Computed Tomography (3D-MDCT) Gastric Volumetry in Patients with obesity and Normal-Weight Individuals

BACKGROUND

Obesity is a widely prevalent medical and socioeconomic problem. Bariatric surgery is indicated for patients with clinically severe obesity. Reduction of gastric volume is an important factor that contributes to weight loss after laparscopic sleeve gastrectomy (LSG). The impact of the gastric volume on weight after LSG has been studied.

AIM OF THE STUDY

This study was designed to assess the gastric volume in patients with obesity prior to LSG and in the normal-weight patients, using three-dimensional multi-detector computer tomography (3D-MDCT), and to evaluate the potential correlation of the gastric volume with body mass index (BMI).

PATIENTS AND METHODS

A total of 100 patients were equally enrolled in two groups: one group for patients with obesity scheduled for LSG and another one for normal-weight patients scheduled for non-bariatric surgery. The study patients underwent 3D-MDCT gastric volumetry.

RESULTS

The gastric volume ranged from 525 to 1170 mL in patients with obesity and from 312 to 676 mL in the normal-weight group. Statistically significant difference was found between the two groups. Age, weight, and BMI were found to be predictors for the gastric volume in normal-weight patients only.

CONCLUSION

MDCT gastric volumetry is a feasible method to assess the stomach volume. Higher volumes were evident in patients with obesity. Age, weight, and BMI are predictors for the gastric volume in normal-weight patients with linear regression equations that could help during the preoperative planning of bariatric surgeries.

Correlation Between Preoperative Gastric Volume and Weight Loss After Laparoscopic Sleeve Gastrectomy

Purpose

Long-term studies reported inadequate weight loss or weight regain after laparoscopic sleeve gastrectomy (LSG). This study investigated a possible relationship between preoperative gastric volume (GV) measured by CT volumetry and weight loss one year after LSG.

Methods

This prospective study included 120 patients scheduled for LSG. 3D CT gastric volumetry was done before surgery. The weight loss in the first year was serially recorded. The primary outcome measure was the correlation between preoperative GV and postoperative weight loss after one year. The secondary outcomes were the correlation between preoperative GV and other patients’ characteristics as age and body mass index (BMI).

Results

Weight and BMI decreased significantly up to 12 months. The percentage of excess weight loss (%EWL) at 6 and 12 months was significantly higher than at three months. Preoperative GV was 1021 ± 253, ranging from 397 to 1543 mL. GV was not related to sex, age, weight, height, postoperative weight, and BMI.

Conclusion

Preoperative gastric volume cannot predict weight loss one year after LSG. It is not correlated with age, sex, or preoperative weight, and BMI.

In vivo models to evaluate ingestible devices: Present status and current trends

Evaluation of orally ingestible devices is critical to optimize their performance early in development. Using animals as a pre-clinical tool can provide useful information on functionality, yet it is important to recognize that animal gastrointestinal physiology, pathophysiology and anatomy can differ to that in humans and that the most suitable species needs to be selected to inform the evaluation. There has been a move towards in vitro and in silico models rather than animal models in line with the 3Rs (Replacement, Reduction and Refinement) as well as the better control and reproducibility associated with these systems. However, there are still instances where animal models provide the greatest understanding. This paper provides an overview of key aspects of human gastrointestinal anatomy and physiology and compares parameters to those reported in animal species. The value of each species can be determined based upon the parameter of interest from the ingested device when considering the use of pre-clinical animal testing.

Impact of Resection Volume/Stapler Firings-Ratio on Perioperative Complications and Weight Loss After Laparoscopic Sleeve Gastrectomy

Background

Major postoperative morbidity after laparoscopic sleeve gastrectomy (LSG) is often related to staple line leaks (SLL). Of note, a recent study suggested a central role of the absolute numbers of stapler firings as a predictive factor for postoperative morbidity due to SLL. In addition, a larger gastric remnant volume could be responsible for lower weight loss after LSG, and nevertheless, the gastric resection volume (GRV) is strictly related to the residual volume.

Methods

Prospectively, collected data of 384 consecutive patients with complete follow-up at 12 months after LSG at our institution were retrospectively analyzed. Patients were stratified according to three different variables (i.e., number of stapler firings, GRV, and GRV/stapler firings-ratio), and respective impact on postoperative complications and weight loss was analyzed.

Results

High absolute number of stapler firings was linked to increased intraoperative and postoperative bleeding and prolonged hospitalization, but was not associated with SLL, transfusion rate or revisional procedures. Absolute GRV showed no impact on both complications and outcome after LSG. Interestingly, higher ratio of GRV/stapler firings was not only linked to decreased intraoperative bleeding and shorter hospital stay but also to higher Excess Body Mass Index Loss (EBMIL) at 12 months after LSG.

Conclusions

Here, we introduce GRV/stapler firings-ratio as a simple predictive factor for identifying patients at risk for postoperative complications and impaired weight loss that is superior compared with absolute number of stapler firings or GRV alone.