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[Demonstration of postgastrectomy bile reflux by hepatobiliary sequential scintigraphy]
Rofo : Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin
|October 1, 1982
Summary
Hepatobiliary sequential scintigraphy can demonstrate bile reflux after gastrectomy, correlating with clinical findings. This functional imaging method is superior to radiology or endoscopy for diagnosing reflux symptoms.
Area of Science:
- Gastroenterology
- Nuclear Medicine
- Surgical Oncology
Background:
- Alkaline reflux esophagitis can occur after gastrectomy with jejunal interposition (Longmire technique).
- This condition results from duodeno-jejunal and jejuno-esophageal bile reflux.
- Accurate diagnosis of bile reflux is crucial for managing post-gastrectomy complications.
Purpose of the Study:
- To evaluate the efficacy of hepatobiliary sequential scintigraphy in demonstrating bile reflux.
- To compare scintigraphy findings with clinical symptoms, endoscopy, biopsies, and radiological examinations.
- To assess inter-observer agreement in interpreting scintigraphy results.
Main Methods:
- Hepatobiliary sequential scintigraphy was performed on 27 patients post-gastrectomy for malignant tumors.
- 45 scintigrams were analyzed, alongside endoscopies, biopsies, and radiological exams.
- Inter-observer agreement among five specialists was investigated.
Main Results:
- Hepatobiliary sequential scintigraphy showed a significant correlation with clinical findings in four out of five observers (p < 0.05).
- Bile reflux was detected in 8/12 symptomatic patients and 4/28 asymptomatic patients.
- Scintigraphy demonstrated higher diagnostic accuracy for reflux symptoms compared to barium meals (correlation 0.25) and endoscopy/biopsy.
Conclusions:
- Functional scintigraphy with digital data recording is reliable for demonstrating or excluding bile reflux.
- Sequential scintigraphy is a valuable tool for clarifying reflux symptoms post-gastrectomy, outperforming traditional radiological and endoscopic methods.
- Further investigation is needed to improve inter-observer agreement in routine clinical use.