Quantitative evaluation of bile diversion surgery utilizing 99mTc HIDA scintigraphy

Area of Science:

• Gastroenterology
• Nuclear Medicine
• Surgical Oncology

Background:

• Billroth II gastrectomy is a common procedure for peptic ulcer disease.
• Post-gastrectomy complications include enterogastric reflux, leading to symptoms like epigastric pain and bleeding.
• Evaluating enterogastric reflux is crucial for patient management.

Observation:

• 21 patients with post-Billroth II gastrectomy symptoms were studied.
• 18 of 21 patients exhibited high enterogastric reflux indices (60%-95%) via 99mTc HIDA scintigraphy.
• Asymptomatic controls showed lower reflux indices (4%-45%).

Findings:

• Diversion antireflux surgery (Roux-en-Y or Henley loop) significantly reduced enterogastric reflux indices (2%-26%, p < 0.00001).
• Surgical intervention led to marked symptom improvement, including anemia correction and weight gain.
• 99mTc HIDA scintigraphy effectively quantifies reflux reduction post-surgery.

Implications:

• 99mTc HIDA scintigraphy is a valuable tool for assessing enterogastric reflux before and after surgical intervention.
• Antireflux surgery offers a viable solution for managing symptomatic enterogastric reflux after Billroth II gastrectomy.
• This study highlights the efficacy of surgical management in improving quality of life for affected patients.