title: Role of preoperative imaging with multidetector computed tomography in the management of patients with gastroesophageal reflux disease symptoms after laparoscopic sleeve gastrectomy.
abstract: BACKGROUND
  The aims of the study were to evaluate if multidetector computed tomography (MDCT) can be helpful and useful in the decision-making process in sleeve patients with gastroesophageal reflux disease (GERD) symptoms and to demonstrate the reproducibility and accuracy of the technique.
  
  
  METHODS
  Twenty-three patients submitted to laparoscopic sleeve gastrectomy (LSG), complaining upper gastrointestinal (GI) symptoms and/or weight regain and candidated to laparoscopic surgical revision were investigated. All patients underwent upper GI barium study, endoscopy, and MDCT for the identification of esophageal dilatation, neofundus development, thoracic sleeve migration, sleeve dilatation, and/or antrum dilatation. Selected patients underwent laparoscopic sleeve revision, cruroplasty, and/or fundectomy according to MDCT findings. Surgical findings were considered as "gold standard." Symptom persistence or resolution was investigated after 6 months with a standard clinical questionnaire. A total of 21 patients with sleeve migration or dilatation and neofundus underwent laparoscopic revision.
  
  
  RESULTS
  A strong correlation between MDCT preoperative findings and intraoperative findings was observed. The presence of sleeve migration was significantly underestimated by both conventional radiology and upper GI endoscopy (sensitivity of 57.1 and 50 %, respectively). Symptom remission was observed in 19 out of 21 patients at 6 months. In two cases, surgical revision was not indicated on the basis of MDCT findings.
  
  
  CONCLUSIONS
  MDCT is more accurate than the conventional radiology and endoscopy for the detection of morphological alteration causing GERD symptoms after LSG and can be considered a valid noninvasive method to guide surgery and monitoring patients following revision.
authors.affiliation: Department of Radiological Sciences, Oncology and Pathology, University of Rome "SAPIENZA", Polo Pontino, I.C.O.T., Via Franco Faggiana 34, 04100, Latina, Italy, marco.rengo@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Rengo
authors.forename: Davide
authors.initials: D
authors.lastname: Bellini
authors.forename: Olga
authors.initials: O
authors.lastname: Iorio
authors.forename: Carlo Nicola
authors.initials: CN
authors.lastname: De Cecco
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzello
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cavallaro
authors.forename: Marilia
authors.initials: M
authors.lastname: Carabotti
authors.forename: Andrea
authors.initials: A
authors.lastname: Laghi
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Silecchia
mesh_terms: D000328:Adult; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D010535:Laparoscopy; D008297:Male; D061330:Multidetector Computed Tomography; D009767:Obesity, Morbid / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011178:Postgastrectomy Syndromes / Q000000981:diagnostic imaging*; D011300:Preoperative Care; D012086:Reoperation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016896:Treatment Outcome