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Lindner S, von Rudno K, Gawlitza J, Hardt J, Sandra-Petrescu F, Seyfried S, Kienle P, Reissfelder C, Bogner A, Herrle F. Flexible endoscopy is enough diagnostic prior to loop ileostomy reversal. Int J Colorectal Dis 2021; 36:413-417. [PMID: 33048240 PMCID: PMC7801265 DOI: 10.1007/s00384-020-03766-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE This study investigates whether contrast enema (CE) and flexible endoscopy (FE) should be performed routinely after low anterior resection (LAR) before ileostomy reversal. Additionally, the impact of previous anastomotic leakage (AL) on diagnostic test accuracy (DTA) was assessed. METHODS This is a retrospective analysis of prospectively collected tertiary care data of two centers. Consecutive rectal cancer patients undergoing LAR with loop ileostomy formation were included. Before ileostomy reversal, all patients were assessed by CE and FE. DTA of FE and CE for asymptomatic AL in patients who had previously suffered from clinically relevant AL (group 1) compared with those without apparent AL after LAR (group 0) were assessed separately. RESULTS Two hundred ninety-three patients were included in the analysis, 86 in group 1 and 207 in group 0. Overall sensitivity for detection of asymptomatic AL was 76% (FE) and 60% (CE). Specificity was 100% for both tests. DTA of FE was equal or superior to CE in all subgroups. Prevalence of asymptomatic AL at the time of testing was 1.4% in group 0 and 25.6% in group 1. CONCLUSION Flexible endoscopy is the more accurate diagnostic test for the detection of asymptomatic anastomotic leaks prior to ileostomy reversal. Contrast enema showed no gain of information. In the group without complications after the initial rectal resection, 104 must be tested to find one leak prior to reversal. In those patients, routine diagnostic testing additional to digital rectal examination may be questioned.
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Affiliation(s)
- S Lindner
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - K von Rudno
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - J Gawlitza
- Department of Radiology, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - J Hardt
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - F Sandra-Petrescu
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - S Seyfried
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Kienle
- Department of Surgery, Theresienkrankenhaus Mannheim, Mannheim, Germany
| | - C Reissfelder
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - A Bogner
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - F Herrle
- Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Gawlitza J, Michels J, Borggrefe M, Schönberg S, Akin I, Saur J, Trinkmann F, Henzler T. Time to exhale: Evaluierung des diagnostischen Mehrwerts von Thorax CT Untersuchungen in Expiration bei Patienten mit COPD – Ergebnisse der CType Studie. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J Gawlitza
- Universitätsmedizin Mannheim, Institut für klinische Radiologie, Mannheim
| | - J Michels
- Universitätsmedizin Mannheim, 1. medizinische Klinik, Mannheim
| | - M Borggrefe
- Universitätsmedizin Mannheim, 1. medizinische Klinik, Mannheim
| | - S Schönberg
- Universitätsmedizin Mannheim, Institut für klinische Radiologie, Mannheim
| | - I Akin
- Universitätsmedizin Mannheim, 1. medizinische Klinik, Mannheim
| | - J Saur
- Universitätsmedizin Mannheim, 1. medizinische Klinik, Mannheim
| | - F Trinkmann
- Universitätsmedizin Mannheim, 1. medizinische Klinik, Mannheim
| | - T Henzler
- Universitätsmedizin Mannheim, Institut für klinische Radiologie, Mannheim
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Gawlitza J, Michels JD, Borggrefe M, Schönberg SO, Akin I, Saur J, Henzler T, Trinkmann F. Time to exhale: quantitative CT-Parameter in Exspiration beinhalten zusätzliche Information bei Patienten mit COPD. Pneumologie 2017. [DOI: 10.1055/s-0037-1598551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- J Gawlitza
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim
| | - JD Michels
- I. Medizinische Klinik, Universitätsmedizin Mannheim
| | - M Borggrefe
- I. Medizinische Klinik, Universitätsmedizin Mannheim
| | - SO Schönberg
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim
| | - I Akin
- I. Medizinische Klinik, Universitätsmedizin Mannheim
| | - J Saur
- I. Medizinische Klinik, Universitätsmedizin Mannheim
| | - T Henzler
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim
| | - F Trinkmann
- I. Medizinische Klinik, Universitätsmedizin Mannheim
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Wang X, Henzler T, Gawlitza J, Diehl S, Wilhelm T, Schoenberg S, Jin Z, Xue H, Smakic A. Image quality of mean temporal arterial and mean temporal portal venous phase images calculated from low dose dynamic volume perfusion CT datasets in patients with hepatocellular carcinoma and pancreatic cancer. Eur J Radiol 2016; 85:2104-2110. [DOI: 10.1016/j.ejrad.2016.09.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/22/2016] [Accepted: 09/24/2016] [Indexed: 01/28/2023]
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Gawlitza J, Haubenreisser H, Meyer M, Hagelstein C, Sudarski S, Schoenberg SO, Henzler T. Comparison of organ-specific-radiation dose levels between 70 kVp perfusion CT and standard tri-phasic liver CT in patients with hepatocellular carcinoma using a Monte-Carlo-Simulation-based analysis platform. Eur J Radiol Open 2016; 3:95-9. [PMID: 27200404 PMCID: PMC4864374 DOI: 10.1016/j.ejro.2016.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 04/25/2016] [Indexed: 02/02/2023] Open
Abstract
Purpose The aim of this study was to systematically compare organ-specific-radiation dose levels between a radiation dose optimized perfusion CT (dVPCT) protocol of the liver and a tri-phasic standard CT protocol of the liver using a Monte-Carlo-Simulation-based analysis platform. Methods and materials The complete CT data of 52 patients (41 males; mean age 65 ± 12) with suspected HCC that underwent dVPCT examinations on a 3rd generation dual-source CT (Somatom Force, Siemens) with a dose optimized tube voltage of 70 kVp or 80 kVp were exported to an analysis platform (Radimetrics, Bayer). The dVPCT studies were matched with a reference group of 50 patients (35 males; mean age 65 ± 14) that underwent standard tri-phasic CT (sCT) examinations of the liver with 130 kVp using the calculated water-equivalent-diameter of the patients. The analysis platform was used for the calculation of the organ-specific effective dose (ED) as well as global radiation-dose parameters (ICRP103). Results The organ-specific ED of the dVPCT protocol was statistically significantly lower when compared to the sCT in 14 of 21, and noninferior in a total of 18 of 21 examined items (all p < 0.05). The EDs of the dVPCT examinations were especially in the dose sensitive organs such as the red marrow (17.3 mSv vs 24.6 mSv, p = < 0.0001) and the liver (33.3 mSv vs 46.9 mSv, p = 0.0003) lower when compared to the sCT. Conclusion Our results suggest that dVPCT performed at 70 or 80 kVp compares favorably to sCT performed with 130 kVp with regard to effective organ dose levels, especially in dose sensitive organs, while providing additional functional information which is of paramount importance in patients undergoing novel targeted therapies.
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Affiliation(s)
- J Gawlitza
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - H Haubenreisser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - M Meyer
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - C Hagelstein
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - S Sudarski
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - S O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - T Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
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