Dual-radionuclide simultaneous gastric emptying and bile transit study after gastric surgery with double-tract reconstruction.
OBJECTIVE
The physiology of gastrointestinal transfer function after proximal gastrectomy with bypass-tract reconstruction is not well understood. We applied a simultaneous dual-radionuclide method with a hepatobiliary imaging and gastric emptying study to evaluate physiologic alterations occurring after surgery.


METHODS
Nineteen patients with early gastric cancer, including 9 preoperative control patients and 10 who had proximal gastrectomy and double-tract reconstruction surgery were examined by dual-radionuclide hepatobiliary and gastric emptying studies (99mTc PMT and 111In DTPA). Retention fraction in the stomach at 3 minutes (R3) and 60 minutes (R60) and gastric emptying half-time (GET) were calculated. Bile reflux and mixture of bile and food were also evaluated.


RESULTS
The retention fractions of R3 and R60 were significantly lower in the double-tract reconstruction group than those in the preoperative group. GET differed significantly between the double-tract and preoperative groups (20.7 min +/- 7.1 min and 36.2 min +/- 11.0 min, p = 0.0018). The mixture of bile and food was not good in the double-tract reconstruction group (p = 0.014 vs. preoperative). Patients with a large residual stomach showed slower initial emptying (p = 0.0068) and a better mixture of bile and food (p = 0.058) compared to those with a small residual stomach. The bile reflux was not significantly increased after surgery.


CONCLUSIONS
The dual-radionuclide gastrointestinal and hepatobiliary imaging was feasible and could demonstrate characteristic transit patterns of the foods and bile in the double-tract reconstruction procedure. A larger residual stomach, if possible, is desirable to provide better transfer and mixing of bile and foods.
Nakajima
Kenichi
K
Department of Nuclear Medicine, Kanazawa University Hospital, Japan. nakajima@med.kanazawa-u.ac.jp
Kawano
Masaya
M
Kinami
Shinichi
S
Fujimura
Takashi
T
Miwa
Koichi
K
Tonami
Norihisa
N
D000368:Aged; D001646:Bile / Q000000981:diagnostic imaging; D001659:Biliary Tract / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy; D005746:Gastric Emptying; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011182:Postoperative Care / Q000379:methods; D011759:Pyrrolidines; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D019651:Plastic Surgery Procedures; D013270:Stomach / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery; D016284:Technetium Tc 99m Pentetate; D013752:Tetracycline; D016896:Treatment Outcome
D015609:Organotechnetium Compounds; D011759:Pyrrolidines; D019275:Radiopharmaceuticals; C057732:technetium Tc 99m pyrrolidino-methyltetracycline; D013752:Tetracycline; D016284:Technetium Tc 99m Pentetate