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Abdom Radiol (NY). 2017 Sep 8. doi: 10.1007/s00261-017-1304-3. [Epub ahead of print]

Diagnosis of gastrogastric fistula on computed tomography: a quantitative approach.

Author information

1
Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, USA. ggaomai@gmail.com.
2
Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, USA.
3
Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, E/CC 4, Boston, MA, 02215, USA.
4
Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, Tompkin's East 2, PO Box 208042, New Haven, CT, 06520-8042, USA.

Abstract

OBJECTIVE:

To determine if the attenuation of contrast material in the excluded stomach compared with the gastric pouch is helpful in diagnosing gastrogastric (GG) fistula.

MATERIALS AND METHODS:

In a retrospective study, 13 CT scans in 12 patients (age 43.2 ± 9.2, 10 females) who had undergone Roux-en-Y gastric bypass and who had oral contrast in both the gastric pouch and excluded stomach were qualitatively and quantitatively evaluated for GG fistula by two radiologists, using upper GI series (UGI) as the gold standard. Quantitative analysis was performed by computing the relative attenuation (RA) ratio (HU in excluded stomach/HU in gastric pouch). Statistical analysis was performed to determine if the RA ratio values correlated with the UGI findings of GG fistula.

RESULTS:

46.2% (6/13) of UGI studies demonstrated a GG fistula. Statistical analysis demonstrated a significant difference in RA ratio (P < 0.05) between the fistula group (1.12 ± 0.29) and the reflux group (0.56 ± 0.19). A receiver operating characteristic analysis identified an RA ratio of 0.8 that maximized sensitivity (100%), at the expense of specificity (78.6%), for diagnosing GG fistula. In contrast, the initial qualitative evaluation for GG fistula yielded a lower sensitivity (45.8%) and a higher specificity (89.2%). After taking RA ratios into account, radiologists' final conclusions achieved higher sensitivity (58.3%) and specificity (100%).

CONCLUSION:

The relative attenuation ratio of oral contrast in the excluded stomach versus the gastric pouch can be a reliable tool in differentiating GG fistula from oral contrast reflux up the biliopancreatic limb on CT.

KEYWORDS:

Gastrogastric fistula; Relative attenuation; Roux-en-Y gastric bypass surgery

PMID:
28884370
DOI:
10.1007/s00261-017-1304-3
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