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Handojo K, Ismaeil A, Van Huele A, Van Neste C, Debergh I, Dillemans B. Roux-en-Y Gastric Bypass as Conversion Procedure of Failed Gastric Banding: Short-Term Outcomes of 1295 Patients in One Single Center. Obes Surg 2023; 33:2963-2972. [PMID: 37548925 PMCID: PMC10514178 DOI: 10.1007/s11695-023-06746-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Laparoscopic adjustable gastric band (LAGB) has high technical and weight loss failure rates. We evaluate here the 1-year morbidity, mortality, and weight loss of laparoscopic Roux-en-Y-gastric bypass (LRYGB) as a feasible conversion strategy. METHODS Patients with a failed primary LAGB who underwent LRYGB from July 2004 to December 2019 were selected from an electronic database at our center. Patients had a conversion to LRYGB at the same time (one-stage approach) or with a minimum of 3 months in between (two-stage approach). Primary outcomes included 30-day morbidity and mortality. Secondary outcomes were body mass index (BMI), percent excess weight loss (%EWL), and percent excess BMI lost (%EBMIL) at 1 year postoperatively. RESULTS A total of 1295 patients underwent a conversion from LAGB to LRYGB at our center: 1167 patients (90.1%) in one stage and 128 patients (9.9%) in two stages. There was no mortality. An early (30-day) postoperative complication occurred in 93 patients (7.2%), with no significant difference found between groups. Hemorrhage was the most common complication in 39 patients (3.0%), and the reoperation was required in 19 patients (1.4%). At 1 year postoperatively, the mean BMI was 28.0 kg/m2, the mean %EWL 72.8%, and the mean %EBMIL 87.0%. No statistically significant difference was found between the groups. CONCLUSION Conversion to LRYGB can be considered as a safe and effective option with low complication rate and good weight loss outcomes at 1 year. One-stage conversion provides the same early outcome as two-step surgery with a competent surgeon.
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Affiliation(s)
- Karen Handojo
- Department of General Surgery, AZ Sint Jan Brugge-Oostende AV, Campus Henri Serruys, 8400 Oostende, Belgium
| | - Aiman Ismaeil
- Department of General Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
- Department of General Surgery, Faculty of Medicine, Aswan University, Aswan, 81528 Egypt
| | - Andries Van Huele
- Department of General Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Isabelle Debergh
- Department of General Surgery, AZ Delta Hospital, Sint-Rembertlaan 21, 8820, Torhout, Belgium
| | - Bruno Dillemans
- Department of General Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
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Vansteenbrugge L, Strypstein S, Biglari M, Debergh I, Smet B. Transoral Outlet Reduction to Tackle Weight Regain After Roux-en-Y Gastric Bypass: a Single Center Initial Experience. Obes Surg 2023:10.1007/s11695-023-06580-9. [PMID: 37067686 DOI: 10.1007/s11695-023-06580-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Long-term failure after Roux-en-Y gastric bypass (RYGB) is well known and occurs in 10-15% of patients according to the literature. Causes are multifactorial and dilatation of the gastro-jejunal anastomosis (GJA) is only one of these. A transoral outlet reduction (TORe) with endoscopic sutures to reinstall more restriction could be a valid and safe alternative to reduce regained weight after failed gastric bypass surgery. The objective of this article is to describe our single-center experience and discuss the adverse events of the technique. OBJECTIVES To describe our single-center case series and adverse events after TORe for weight regain after RYGB. METHODS We report a case series of 20 patients referred due to weight regain after RYGB with a dilated GJA. TORe was performed using an endoscopic full-thickness suture device (Apollo OverStitch®) to reduce the diameter of the GJA and the volume of the gastric reservoir. Prospectively collected data on technical feasibility, safety and efficacy are described with a median follow-up of 22 (6-38) months. RESULTS Mean BMI was 44.5 kg/m2 at the time of RYGB. Postoperative nadir BMI was 27,7 kg/m2. The average time to TORe was 12.1 years after initial RYGB. Patients regained a mean 45.9% of excess body weight loss (EWL) before TORe and had a mean preprocedural BMI of 35.3 kg/m2. The aim was to reduce the aperture of the GJA to 5 mm which was done with a mean of 1.7 sutures and 3.5 stitches. The mean absolute weight loss was 13 kg and BMI reduction was 3.9 kg/m2 after 6 months. After a median follow-up of 22 months, a BMI of 31.4 kg/m2 was observed. Dumping symptoms resolved in four of our patients 6 weeks after TORe. Procedural adverse events were nausea and vomiting, sore throat, mild transient abdominal pain, diarrhea and constipation. All of them were treated conservatively. Due to a lack of weight loss, a suture failure was assumed in two of our patients. We describe one case of postprocedural mediastinitis, presumably due to a distal esophageal perforation, treated with a laparoscopic drainage without clinical evidence for perforation. CONCLUSIONS Endoscopic TORe by narrowing the dilated GJA appears to be an efficient and safe minimal invasive option to tackle weight regain after RYGB and should be more used in clinical practice.
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Affiliation(s)
- Louis Vansteenbrugge
- General and Abdominal Surgery Department, AZ Delta Hospital, Deltalaan 1, 8800, Roeselare/Torhout, Belgium.
| | - Sébastien Strypstein
- General and Abdominal Surgery Department, AZ Delta Hospital, Deltalaan 1, 8800, Roeselare/Torhout, Belgium
| | | | - Isabelle Debergh
- General and Abdominal Surgery Department, AZ Delta Hospital, Deltalaan 1, 8800, Roeselare/Torhout, Belgium
| | - Bart Smet
- General and Abdominal Surgery Department, AZ Delta Hospital, Deltalaan 1, 8800, Roeselare/Torhout, Belgium
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Jacobs K, Vleeschouwers W, Debergh I, Haesen D, Dillemans B. Laparoscopic Adjustable Gastric Banding with the Adhesix® Bioring® for Weight Regain or Insufficient Weight Loss After a Roux-en-Y Gastric Bypass: Midterm Data from the Pronto Registry. Obes Surg 2021; 31:4295-4304. [PMID: 34275109 DOI: 10.1007/s11695-021-05537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Although Roux-en-Y gastric bypass (RYGB) is one of the most common bariatric procedures, insufficient weight loss is described to be as high as 20-35%. To treat weight regain/inadequate weight loss, laparoscopic adjustable gastric banding (LAGB) could be a feasible revisional strategy. MATERIALS AND METHODS We report on a prospective study which included 35 patients who presented inadequate weight loss or significant weight regain after primary RYGB (percentage excess weight loss [%EWL] at revision < 50%). All patients underwent revisional LAGB with the placement of an Adhesix® Bioring® adjustable gastric band (Cousin Biotech, Wervicq-Sud, France). Patients' weight loss, complications, frequency of revisions and quality of life were evaluated. RESULTS Follow-up data at 24 months are available for 80% of the included patients. The mean BMI before RYGB was 43.6 ± 5.4 kg/m2 and before revisional LAGB was 38.8 ± 4.3kg/m2. The %EWL before revisional surgery was 23.3 ± 24.8%. The average time between both procedures was 6.7 (mean) ± 3.6 (SD) years. Twenty-four months after revisional LAGB, the average BMI calculated from the weight at RYGB dropped to 32.0 ± 4.5 kg/m2, with an additional %EWL of 49.9 ± 30.3% resulting in a total %EWL of 60.7 ± 28%. The reoperation rate for complications related to LAGB was 21.2%. No band erosions occurred, but two bands needed to be removed during the study. CONCLUSION Revisional LAGB may be considered a valid salvage procedure in patients with weight regain or inadequate weight loss after RYGB, though band- and port-related complications remain a notable concern.
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Affiliation(s)
- Karen Jacobs
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Bruges, Belgium.
| | - Wouter Vleeschouwers
- Department of General Surgery, AZ Sint-Elisabeth Zottegem, 9620 Zottegem, Godveerdegemstraat 69, Belgium
| | - Isabelle Debergh
- Department of general surgery, AZ Delta Hospital, 8820 Torhout, Sint-Rembertlaan 21, Belgium
| | - Dorien Haesen
- Archer Research CRO, Agoralaan Building A bis, 3590, Diepenbeek, Belgium
| | - Bruno Dillemans
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Bruges, Belgium
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Khewater T, Yercovich N, Grymonprez E, Debergh I, Dillemans B. Conversion of both Versions of Vertical Banded Gastroplasty to Laparoscopic Roux-en-Y Gastric Bypass: Analysis of Short-term Outcomes. Obes Surg 2020; 29:1797-1804. [PMID: 30756295 DOI: 10.1007/s11695-019-03768-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Conversional bariatric surgery has relatively high rates of complications. We aimed to analyze our single-center experience with patients requiring conversional laparoscopic Roux-en-Y gastric bypass (LRYGB) following a failed primary open or laparoscopic vertical banded gastroplasty (OVBG or LVBG, respectively). METHODS The records of patients who underwent LRYGB as a conversional procedure after VBG between November 2004 and December 2017 were reviewed. Characteristics, body mass index (BMI), operation time, intraoperative problems, length of hospitalization, and early (< 30 days) morbidity and mortality were analyzed. Data were expressed as mean ± standard deviation or frequency. RESULTS A total of 329 patients (81.76% females) who underwent conversional RYGB were included. For the LVBG group (224 patients) and OVBG group (105 patients), respectively, BMI was 34.15 ± 6.38 and 37.79 ± 6.31 kg/m2 (p < 0.05), the operation time was 96.00 ± 31.40 and 123.15 ± 40.26 min (p < 0.05), hospitalization duration was 2.96 ± 1.13 and 3.20 ± 1.20 days (p = 0.08), the early complication rate was 7.14 and 11.43% (p = 0.19), and the reoperation rate was 2.23 and 2.86% (p = 0.73). There were no major intraoperative problems. Three patients with OVBG were converted to open RYGB (2.86%). There was no mortality. CONCLUSION The conversion of OVBG and LVBG to laparoscopic RYGB is technically feasible and provides comparably low early morbidity rates and length of hospitalization. However, compared to LVBG, conversional laparoscopic RYGB following OVBG is technically more challenging and time-consuming, with a slightly higher risk of conversion to open surgery. We support the use of such conversional bariatric surgery in specialized, high-volume bariatric centers.
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Affiliation(s)
- Talal Khewater
- Department of Surgery, AZ Sint-Jan Brugge-Oostende AV, Campus Sint-Jan, Ruddershove 10, 8000, Bruges, Belgium.
| | - Nathalie Yercovich
- Department of Surgery, AZ Sint-Jan Brugge-Oostende AV, Campus Sint-Jan, Ruddershove 10, 8000, Bruges, Belgium
| | - Edouard Grymonprez
- Student at Faculty of Medicine, KU Leuven University, Herestraat 49, 3000, Leuven, Belgium
| | - Isabelle Debergh
- Department of Surgery, AZ Sint-Jan Brugge-Oostende AV, Campus Sint-Jan, Ruddershove 10, 8000, Bruges, Belgium
| | - Bruno Dillemans
- Department of Surgery, AZ Sint-Jan Brugge-Oostende AV, Campus Sint-Jan, Ruddershove 10, 8000, Bruges, Belgium
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Abstract
AIMS This study presents the cost-effectiveness analysis of bariatric surgery in Belgium from a third-party payer perspective for a lifetime and 10-year horizon. MATERIALS AND METHODS A decision analytic model incorporating Markov process was developed to compare the cost-effectiveness of gastric bypass, sleeve gastrectomy, and adjustable gastric banding against conventional medical management (CMM). In the model, patients could undergo surgery, or experience post-surgery complications, type 2 diabetes, cardiovascular diseases, or die. Transition probabilities, costs, and utilities were derived from the literature. The impact of different surgical methods on body mass index (BMI) level in the base-case analysis was informed by the Scandinavian Obesity Surgery Registry and the Swedish Obese Subject (SOS) study. Healthcare resource use and costs were obtained from Belgian sources. A base-case analysis was performed for the population, the characteristics of which were obtained from surgery candidates in Belgium. RESULTS In the base-case analysis over a 10-year time horizon, the increment in quality-adjusted life-years (QALYs) gained from bariatric surgery vs CMM was 1.4 per patient, whereas the incremental cost was €3,788, leading to an incremental cost-effectiveness ratio (ICER) of €2,809 per QALY. Over a lifetime, bariatric surgery produced savings of €9,332, an additional 1.1 life years and 5.0 QALYs. Bariatric surgery was cost-effective at 10 years post-surgery and dominant over conventional management over a lifetime horizon. LIMITATIONS The model did not include the whole scope of obesity-related complications, and also did not account for variation in surgery outcomes for different populations of diabetic patients. Also, the data about management of patients after surgery was based on assumptions and the opinion of a clinical expert. CONCLUSIONS It was demonstrated that a current mix of bariatric surgery methods was cost-effective at 10 years post-surgery and cost-saving over the lifetime of the Belgian patient cohort considered in this analysis.
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Affiliation(s)
- Oleg Borisenko
- a Health Economics and Market Access , Synergus AB , Danderyd ( Stockholm ), Sweden
| | - Vasily Lukyanov
- b Health Economics , Synergus AB , Danderyd (Stockholm) , Sweden
| | - Isabelle Debergh
- c Dienst Algemene, Vaat- en Kinderheelkunde, AZ Sint-Jan Brugge-Oostende AV, campus Sint-Jan , Ruddershove 10 , 8000 Brugge , Belgium
| | - Bruno Dillemans
- c Dienst Algemene, Vaat- en Kinderheelkunde, AZ Sint-Jan Brugge-Oostende AV, campus Sint-Jan , Ruddershove 10 , 8000 Brugge , Belgium
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Debergh I, Defoort B, De Visschere M, Flahou S, Van Cauwenberge S, Mulier JP, Dillemans B. A one-step conversion from gastric banding to laparoscopic Roux-en-Y gastric bypass is as safe as a two-step conversion: A comparative analysis of 885 patients. Acta Chir Belg 2016; 116:271-277. [PMID: 27903129 DOI: 10.1080/00015458.2016.1255005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS To achieve additional weight loss or to resolve band-related problems, a laparoscopic adjustable gastric banding (LAGB) can be converted to a laparoscopic Roux-en-Y gastric bypass (RYGB). There is limited data on the feasibility and safety of routinely performing a single-step conversion. We assessed the efficacy of this revisional approach in a large cohort of patients operated in a high-volume bariatric institution. METHODS Between October 2004 and December 2015, a total of 885 patients who underwent LAGB removal with RYGB were identified from a prospectively collected database. In all cases, a single-stage conversion procedure was planned. The feasibility of this approach and peri-operative outcomes of these patients were evaluated and analyzed. RESULTS A single-step approach was successfully achieved in 738 (83.4%) of the 885 patients. During the study period, there was a significant increase in performing the conversion from LAGB to RYGB single-staged. No mortality or anastomotic leakage was observed in both groups. Only 45 patients (5.1%) had a 30-d complication: most commonly hemorrhage (N = 20/45), with no significant difference between the groups. CONCLUSION Converting a LAGB to RYGB can be performed with a very low morbidity and zero-mortality in a high-volume revisional bariatric center. With increasing experience and full standardization of the conversion, the vast majority of operations can be performed as a single-stage procedure. Only a migrated band remains a formal contraindication for a one-step approach.
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Affiliation(s)
- Isabelle Debergh
- Department of Surgery, AZ Sint-Jan Brugge ? Oostende AV, Campus Brugge, Brugge, Belgium
| | | | | | - Silke Flahou
- Department of Surgery, AZ Sint-Jan Brugge ? Oostende AV, Campus Brugge, Brugge, Belgium
| | | | - Jan P. Mulier
- Department of Anesthesia, AZ Sint-Jan Brugge ? Oostende AV, Campus Brugge, Brugge, Belgium
| | - Bruno Dillemans
- Department of Surgery, AZ Sint-Jan Brugge ? Oostende AV, Campus Brugge, Brugge, Belgium
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Debergh I, Snauwaert C, Dillemans B. New devices for the bariatric patient. MINERVA CHIR 2016; 71:114-123. [PMID: 26923812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Over the past years, the global prevalence of obesity has risen dramatically. This generates enormous costs for the health care system, since obesity is associated with hypertension, diabetes mellitus type 2, coronary heart diseases, stroke, dyslipidemia, psychological problems, and cancer. Bariatric surgery has demonstrated to be the most effective and durable treatment option in the morbidly obese patient. Despite its evidence based efficacy, less than 1% of obese patients will undergo surgery. The role of new, less-invasive devices for the bariatric patient needs to be defined. Are they situated in the gap between lifestyle modification and surgery for the obese patient, in the preoperative work-up of the super-obese patient, in patient groups that are currently excluded for surgery, and/or in the routine treatment of obesity as a chronic disease? This review will focus on emerging technologies for the bariatric patient that are currently in clinical practice or in an advanced development stage, with different modes of action: inducing stretch on the gastric wall (space-occupying or stitching devices), vagal neuromodulation, altering the absorption, or exclusion of the duodenum and proximal jejunum. Exploring the evidence and the indication of different therapeutic approaches and innovations will be an interesting field of research in the near future.
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Affiliation(s)
- Isabelle Debergh
- Department of Surgery, AZ Sint-Jan AV Brugge, Oostende, Campus Brugge, Brugge, Belgium -
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Debergh I, Van Damme N, De Naeyer D, Smeets P, Demetter P, Robert P, Carme S, Pattyn P, Ceelen W. Molecular imaging of tumor-associated angiogenesis using a novel magnetic resonance imaging contrast agent targeting αvβ 3 integrin. Ann Surg Oncol 2013; 21:2097-104. [PMID: 24356800 DOI: 10.1245/s10434-013-3444-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND The recent introduction of biological anticancer therapy has renewed the interest in functional imaging of tumor-associated angiogenesis (TAA) as a tool to monitor early therapy response. The present study evaluated imaging of TAA using P1227, a novel, small molecular magnetic resonance imaging (MRI) probe targeting αvβ3 integrin. METHODS HT29 human colorectal cancers were grown in athymic mice. Dynamic MRI was performed using a three-dimensional VIBE sequence up to 110 min after injection of P1227 or gadolinium-tetraazacyclododecane tetraacetic acid (Gd-DOTA). Specificity was assessed by using P1227 1 h after intravenous administration of the αvβ3 inhibitor cilengitide. Regions of interest were drawn encompassing the tumor rim and normal muscle. Imaging data were compared with microvessel density and αvβ3 expression. RESULTS Using P1227, specific enhancement of the angiogenic tumor rim, but not of normal muscle, was observed, whereas Gd-DOTA enhanced tumor and normal muscle. After administering cilengitide, enhancement with P1227, but not with DOTA, was significantly suppressed during the first 20 min. When using P1227, a significant correlation was observed between normalized enhancement of the tumor rim and immunohistochemical αvβ3 integrin expression. CONCLUSIONS Molecular MRI using a small monogadolinated tracer targeting αvβ3 integrin and moderate magnetic field strength holds promise in assessing colorectal TAA.
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Abstract
Cancer is rapidly becoming the worldwide leading cause of premature death. Iconographic techniques have traditionally provided information on tumor anatomy. The recent introduction of functional and molecular imaging techniques allows probing tumor physiology and biology in addition to mere anatomical description. In addition to the research implications, these novel imaging techniques offer early response assessment and target visualization which, in the era of personalized medicine, may offer significant advances in cancer therapy. Here, we provide an overview of the most important developments in cancer imaging, with a focus on the clinical applications.
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Affiliation(s)
- I Debergh
- Department of Surgery, Ghent University Hospital, Ghent, Belgium
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De Naeyer D, Debergh I, De Deene Y, Ceelen WP, Segers P, Verdonck P. First order correction for T2*-relaxation in determining contrast agent concentration from spoiled gradient echo pulse sequence signal intensity. J Magn Reson Imaging 2011; 34:710-5. [PMID: 21769976 DOI: 10.1002/jmri.22681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 05/23/2011] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate the accuracy of a method neglecting T(2)*-relaxation, for the conversion of spoiled gradient echo pulse sequence signal intensity to contrast agent (CA) concentration, in dynamic contrast enhanced MRI studies. In addition a new closed form conversion expression is proposed that accounts for a first order approximation of T(2)*-relaxation. MATERIALS AND METHODS The accuracy of both conversion methods is compared theoretically by means of simulations for four pulse sequences from literature. Both methods are tested in vivo against the numerical conversion method for measuring the arterial input function in mice. RESULTS Simulations show that the T(2)*-neglecting method underestimates typical tissue CA concentrations (0 mM to 2 mM) up to 6%, while the errors for arterial concentrations (0 mM to 10 mM) range up to 43%. The results from our first order method are numerically indistinguishable from the simulation input values in tumor tissue, while for arterial concentrations the error is reduced up to a factor 10. In vivo, peak Gd-DOTA concentration is underestimated up to 14% with the T(2)*-neglecting method and up to 0.9% with our first order method. CONCLUSION Our conversion method reduces the underestimation of CA concentration severely in a broad physiological concentration range and is easy to perform in any clinical setting.
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Affiliation(s)
- Dieter De Naeyer
- Institute Biomedical Technology (IBiTech), Department of Civil Engineering, Ghent University, Belgium.
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Debergh I, Van Damme N, Pattyn P, Peeters M, Ceelen WP. The low-molecular-weight heparin, nadroparin, inhibits tumour angiogenesis in a rodent dorsal skinfold chamber model. Br J Cancer 2010; 102:837-43. [PMID: 20125158 PMCID: PMC2833243 DOI: 10.1038/sj.bjc.6605535] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/10/2009] [Accepted: 12/16/2009] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Recently, low-molecular-weight heparins (LMWHs) were found to confer a survival advantage in cancer patients. The mechanism underlying this observation is unclear, but may involve inhibition of tumour angiogenesis. We aimed to examine the effects of nadroparin on tumour angiogenesis using a dorsal skinfold window chamber model in the Syrian hamster. METHODS AMel-3 and HAP-T1 tumours were grown in donor animals and fragments implanted in the window chambers. Animals (N=46) were treated with 200 IU of nadroparin or saline for 10 days. Repeated intravital fluorescence microscopy was performed to calculate functional microcirculatory parameters: number (N) and length (L) of microvessels, vascular area fraction (AF), and red blood cell velocity (V). Microvessel density (MVD), fractal dimension, and pericyte coverage were assessed histologically. RESULTS Active angiogenesis was observed in control animals, resulting in a significant increase in N, L, and AF. In nadroparin-treated animals, however, N and L did not increase whereas AF decreased significantly. Both groups showed an initial increase in V, but nadroparin treatment resulted in an earlier decrease in red blood cell velocity over time. Compared with control animals, nadroparin-treated animals showed a significantly lower MVD and fractal dimension but significantly higher pericyte coverage index (PCI). CONCLUSIONS Taken together, these results suggest that the LMWH nadroparin inhibits tumour angiogenesis and results in microvessel normalisation.
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Affiliation(s)
- I Debergh
- Department of Surgery, University Hospital, Ghent B-9000, Belgium
| | - N Van Damme
- Department of Gastroenterology, University Hospital, Ghent B-9000, Belgium
| | - P Pattyn
- Department of Surgery, University Hospital, Ghent B-9000, Belgium
| | - M Peeters
- Department of Gastroenterology, University Hospital, Ghent B-9000, Belgium
| | - W P Ceelen
- Department of Surgery, University Hospital, Ghent B-9000, Belgium
- Senior Clinical Investigator of the Research Foundation – Flanders (Belgium) (FWO)
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