Improved scintigraphic assessment of occult leakages in adjustable gastric bands using 99mTc-labelled human albumin colloid.
BACKGROUND
Adjustable gastric banding has become the preferred procedure in Europe for the treatment of morbid obesity. A complication of this treatment is the presence of leakage in the system. The knowledge of the localization of the leak is essential for planning the reoperation procedure.


METHODS
In a series of 325 adjustable gastric bandings, we observed 10 band leakages. In 3 cases, fluoroscopy failed to detect fluid extravasation. We present a sensitive and simple scintigraphic method for the detection of gastric band leakage in these patients using 37 MBq of a 99mTc-human albumin colloid suspension. Imaging was started immediately after the dose application. During the first minute, images were acquired dynamically with 1 frame every 2 seconds. Afterwards, a static image was obtained every 10 minutes, up to 60 minutes post-injection. Then the system was emptied completely to detect tracer extravasation and consecutive reabsorption during 60 minutes. The study was analyzed by using the regions of interest (ROI) technique drawn on the following points: injection reservoir, tube, anterior band, posterior band, and an adjacent region which was taken as background.


RESULTS
During the first hour, ROI analysis showed a clear diminution in the number of counts contained in the defect parts of the band, whereas it remained constant in the other locations. After system emptying, detection of tracer extravasation further strengthened the diagnosis of band leakage in all patients.


CONCLUSIONS
This new approach using the 99mTc-human albumin colloid suspension with ROI analysis is an effective and simple method to detect occult leakages in adjustable gastric bands which escaped detection by fluoroscopy. In contrast to previously described scintigraphic methods, this investigation is able to demonstrate the exact site of leakage.
Weiss
H
H
Department of General Surgery, Radiology, University Hospital Innsbruck, Austria.
Peer
R
R
Nehoda
H
H
Labeck
B
B
Bonatti
H
H
Aigner
F
F
Donnemiller
E
E
Erler
H
H
Moncayo
R
R
D000328:Adult; D015992:Body Mass Index; D001835:Body Weight; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation / Q000379:methods / Q000592:standards; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods / Q000592:standards; D011877:Radionuclide Imaging / Q000295:instrumentation / Q000379:methods / Q000592:standards; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013668:Technetium Tc 99m Aggregated Albumin; D017211:Treatment Failure; D015431:Weight Loss
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin