Swallow Magnetic Resonance Imaging Compared to 3D-Computed Tomography for Pouch Assessment and Hiatal Hernias After Roux
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ORIGINAL CONTRIBUTIONS
Swallow Magnetic Resonance Imaging Compared to 3D-Computed Tomography for Pouch Assessment and Hiatal Hernias After Roux-en-Y Gastric Bypass Daniel M. Felsenreich 1 & Michael A. Arnoldner 2 & Felix B Langer 1 & Christoph Bichler 1 & Natalie Vock 1 & Katharina Steinlechner 1 & Mahir Gachabayov 1 & Aram Rojas 1 & Dietrich Beitzke 2 & Thomas Mang 2 & Gerhard Prager 1 Christiane Kulinna-Cosentini 2
&
# The Author(s) 2020
Abstract Introduction/Purpose Weight regain and weight loss failure after bariatric surgery are important issues that may require a weight regain procedure. Three-dimensional-computed tomography (3D-CT) is a well-established method allowing exact measurements of pouch volume. The aims of this study were to prove the applicability of swallow MRI as a non-ionizing procedure and compare it to 3D-CT in patients after weight regain procedures following RYGB. Materials and Methods Twelve post-RYGB patients who had a follow-up operation for weight regain before 12/2017 were included in this prospective study. Swallow MRI and 3D-CT were performed in each patient to evaluate the size of the anastomosis, pouch volume, and intrathoracic pouch migration (ITM). Results Mean pouch volume in swallow MRI and 3D-CT were 40.4 ± 21.0 ml and 43.5 ± 30.2 ml, respectively (p = 0.83), and pouch diameter at the maximal distention was 35.3 ± 5.9 ml (MRI) and 31.0 ± 10.0 ml (CT) (p = 0.16). The rate of ITM was 75% in both examinations (p = 1.0). Conclusion Swallow MRI is a valid method for the assessment of pouch volume in different phases of the swallowing process and is comparable to 3D-CT. The diagnosis of ITM using swallow MRI was equal to 3D-CT. Keywords Roux-en-Y gastric bypass . 3D-volumetry . Swallow MRI . Weight regain
Background The number of bariatric surgical procedures performed worldwide increases every year and exceeded 685,000 in 2016. Roux-en-Y Gastric Bypass (RYGB) was the most common
Daniel M. Felsenreich and Michael A. Arnoldner contributed equally to this work. * Gerhard Prager [email protected] 1
Department of Surgery, Division of General Surgery, Vienna Medical University, Waehringer Guertel 18-20, 1090 Vienna, Austria
2
Department of Biomedical Imaging and Image-guided Therapy, Vienna Medical University, Vienna, Austria
procedure until 2014, when sleeve gastrectomy (SG) was more commonly performed. More than 7% of all bariatric procedures are revisional operations due to weight regain [1]. There is a consensus that obesity is to be considered a chronic disease and some patients may need more than one bariatric procedure to achieve sufficient long-term weight loss [2]. As revisional surgery is (and will increasingly be) an important issue, elucidating the reason for weight loss failure, and weight regain is a major concern [3]. Following RYGB, both of these issues are often associated with a dilated pouch, a remnant fundus at the top of the pouch after incomplete mobilization of the fundus, or a widened anastomosis [4]. Thus, the most commonly used examinatio
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