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Author Spotlight: Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care
Published on: September 22, 2023
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Quantification of gastric sleeve stenosis using endoscopic parameters and image analysis
Jessica X Yu1, Russell D Dolan1, Sean Bhalla1
1Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
Gastrointestinal Endoscopy
|December 14, 2020
Summary
Gastric sleeve stenosis (GSS) can now be diagnosed using new endoscopic criteria. The ratio of narrowest to widest gastric lumen diameter and fluid pooling help identify GSS, aiding in management.
Area of Science:
- Bariatric Surgery
- Gastroenterology
- Endoscopic Diagnostics
Background:
- Sleeve gastrectomy is the most common bariatric surgery, leading to an increase in gastric sleeve stenosis (GSS) cases.
- Current management of GSS with pneumatic dilation is effective but underutilized due to a lack of quantitative diagnostic criteria.
- Objective quantification of GSS is needed to improve patient management and treatment outcomes.
Purpose of the Study:
- To develop and validate quantifiable endoscopic criteria for diagnosing gastric sleeve stenosis (GSS).
- To assess the ratio of narrowest to widest gastric lumen diameter, endoscope trajectory, and fluid pooling as diagnostic markers.
- To compare these endoscopic criteria with endoluminal functional lumen imaging probe (EndoFLIP) measurements and endoscopic morphology.
Main Methods:
- Retrospective review of a prospectively maintained database of patients undergoing endoscopy for GSS assessment.
- Blinded review of endoscopic images by two bariatric endoscopists to determine lumen diameters, endoscope trajectory, and fluid pooling.
- Calculation of diameter ratios and comparison with EndoFLIP parameters (diameter and distensibility indices) and documented lumen morphology.
Main Results:
- Twenty-six out of thirty patients (87%) exhibited stenosis, categorized as mild, moderate, or severe.
- Patients with stenosis showed significantly lower diameter ratios (.27 ± .14 vs .48 ± .77) and were more likely to have fluid pooling (96.2% vs 25%).
- Diameter ratio was inversely related to stenosis severity, while endoscope trajectory did not differ significantly between groups.
Conclusions:
- Quantifiable endoscopic criteria, specifically the diameter ratio and presence of fluid pooling, are associated with GSS diagnosis.
- These findings suggest potential for improved GSS diagnosis and management through objective endoscopic assessment.
- Further studies are required to validate these proposed endoscopic criteria for clinical use.
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