Role of 3D volumetry CT in the correlation between postoperative gastric volume and weight loss in obese patients undergoing gastric sleeve surgery.

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1 Role of 3D volumetry CT in the correlation between postoperative gastric volume and weight loss in obese patients undergoing gastric sleeve surgery. Poster No.: C-2145 Congress: ECR 2014 Type: Scientific Exhibit Authors: H. P. Márquez Masquiaran, V. Benito Santamaría, J. A. Hernández, M. M. Menso, D. Hernandez, J. C. PERNAS, C. Perez; Barcelona/ES Keywords: DOI: Eating disorders, Computer Applications-3D, CT, Stomach (incl. Esophagus), Abdomen /ecr2014/C-2145 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8

Perez; Barcelona/ES Keywords: DOI: Eating disorders, Computer Applications-3D, CT, Stomach (incl. Esophagus), Abdomen 10.

2 Aims and objectives Morbid obesity is considered the largest epidemic in the developed world in the twentyfirst century and is associated with multiple comorbidities and a high risk of death from cancer (1). Is defined as a body mass index (BMI): BMI> 40 kg/m2 or BMI> 35 kg/m2 accompanied by comorbidities (metabolic, cardiovascular, respiratory, musculoskeletal). Currently, surgery is the only treatment capable of achieving a marked reduction in BMI, and is associated with improvement in quality of life and overall long-term mortality (2-5). Multiple bariatric procedures have been described, being the gastric bypass the gold standard intervention. Sleeve gastrectomy (SG) consists of the realization of a vertical section of the stomach, progressing cranially to the esophagogastric junction. Before the procedure, a Foucher catheter is inserted to adjust the diameter of the tubular gastric remnant. Tracking short and medium term series of patients undergoing SG, has shown excellent results in terms of weight loss and comorbidities, comparable to those obtained with gastric bypass. The variability of the volume of the reservoir depends on two crucial technical aspects: the volume of residual gastric antrum and the thickness of the endogastric probe. Current techniques recommendations come from meetings of experts consensus, based on the collective experience and not from properly designed clinical trials. In recent years, simulation and anatomical reconstruction 3D techniques have been developed (6,7). This techniques could allow to mesure the exact dimensions of the reservoirs and study their correlation with clinical outcomes. The main objective of this study is to assess radiologically the volumetric variation of the gastric reservoir and see its influence on postoperative weight loss. Methods and materials Selection of patients Descriptive prospective single-center study. We included 25 patients diagnosed with morbid obesity that it would be undergoing sleeve gastrectomy between January 2012 and July Were 9 males and 16 females from 25 to 68 years old. Image technique Page 2 of 8

Currently, surgery is the only treatment capable of achieving a marked reduction in BMI, and is associated with improvement in quality of life and overall long-term mortality (2-5).

3 An abdominal computed tomography (CT) was performed in a multislice device, after maximum tolerated oral administration of contrast (Gastrografin diluted 3%) mixed up with bicarbonatio sodium, in order to distend the gastric chamber through the gas of the reaction. Immediately after administration, a CT was performed without intravenous contrast in supine position, including from the tracheal carina to pubic symphysis. Slice thickness of 2 mm was used, an increase of 1 mm and a voltage of 120 kv. Later, using Philips IntelliSpace 3D software, reconstructions of the gastric camera and automatic estimation of gastric volume was done. This procedure was performed twice for each patient: prior to surgery and one month after surgery. Statistical analysis The variables analyzed were the percentage of weight loss and the pre and postoperative gastric volume. Images for this section: Page 3 of 8

Immediately after administration, a CT was performed without intravenous contrast in supine position, including from the tracheal carina to pubic symphysis.

4 Fig. 1: 3D reconstruction of the stomach (a) in a 56 years old male patient. Note how the volume is authomatically calculated by the program. On the other image (b) it can be seen the anatomic situation of the stomach. Fig. 2: The same patient of fig.1, one month after gastric sleeve surgery, where the reduction of gastric volume is notorious (a). The other image shows the new anatomical situation of the gastric punch. Page 4 of 8

On the other image (b) it can be seen the anatomic situation of the stomach. Fig. 2: The same patient of fig.

5 Results Evaluation of gastric volumes was successful in the 25 examinations (100%). Analyzing the percentage of decrease in gastric volume correlated with the percentage of weight loss of each patient, it was noted that all patients lost some weight, in greater or lesser degree. When sorting data, it was observed that patients with less post surgical gastric volumes, had the highest percentage of weight loss a month after surgery (Table 1). It was seen that the group of patients with a decrease of gastric volume over 90%, showed a weight loss over 10%. Only one patient didn't follow this tendence, with a big weight loss (17%) associated with one of the lower percentage of gastric volume loss between all patients. Images for this section: Page 5 of 8

degree. When sorting data, it was observed that patients with less post surgical gastric volumes, had the highest percentage of weight loss a month after surgery (Table 1).

6 Table 1: This dispertion graphic shows how patients with the higher percentage of gastric volume loss, shows the higher weight loss one month after surgery. Page 6 of 8

7 Conclusion It is important to highlight that this is a work in progress, so we are presenting preliminary results. The primary aim of this investigation is to study the results after a year of surgery. However, this results are quite orientative. Analyzing this group of 25 patients, we found that the volume of the gastric pouch after gastric sleeve surgery, influences weight loss one month after completion of the intervention, since we observed that patients with higher percentages of loss of gastric volume were also those who lost more weight. Also worth mentioning that 3D reconstruction of the stomach and automatic calculation of the gastric volume are easy to use tools, both pre and post surgical. An important technical issue we found after sleeve surgery was that the emptying of the stomach is much faster, so it's harder to distend the gastric remanent. The following of this patients after one year of the surgery is now been performed and the results will come to complete the preliminary information shared on this study. Personal information References 1. Calle EE, Rodríguez C, Walker-Thurmond K, Thin MJ. Overweight, obesity and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 2003; 348 : Ridley N : Expert panel on weight loss surgery - executive report. Obes Surg 2005;13: Sjostrom L, Narbro K. Swedish Obese Subjects Study : Effects of bariatric surgery on mortality in Swedish obese subjects.n Engl J Med 2007;357: Page 7 of 8

Analyzing this group of 25 patients, we found that the volume of the gastric pouch after gastric sleeve surgery, influences weight loss one month after completion of the intervention, since we

8 4. Sjostrom L, Lindroos AK. Swedish Obese Subjects Study : Lifestyle, diabetes and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351: Adams TD, Gress RE. Long-term mortality after gastric bypass surgery. N Engl J Med 2007;357: Alva S, Eisenberg D, Duffy A, Roberts K, Israel G, Bell R. Virtual three-dimensional computed tomography assessment of the gastric pouch following laparoscopic Roux-Y gastric bypass. Obes Surg Apr;18(4): Karcz WK, Kuesters S, Marjanovic G, Suesslin D, Kotter E, Thomusch O, Hopt UT, Felmerer G, Langer M, Baumann T. 3D-MSCT gastric pouch volumetry in bariatric surgery-preliminary clinical results. Obes Surg Apr;19(4): Page 8 of 8

Virtual three-dimensional computed tomography assessment of the gastric pouch following laparoscopic Roux-Y gastric bypass. Obes Surg. 2008 Apr;18(4):364-6. 7.

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