PMID- 32133588
OWN - NLM
STAT- MEDLINE
DCOM- 20210414
LR  - 20210414
IS  - 1708-0428 (Electronic)
IS  - 0960-8923 (Linking)
VI  - 30
IP  - 5
DP  - 2020 May
TI  - HIDA and Seek: Challenges of Scintigraphy to Diagnose Bile Reflux Post-Bariatric 
      Surgery.
PG  - 2038-2045
LID - 10.1007/s11695-020-04510-7 [doi]
AB  - INTRODUCTION: Oesophageal bile reflux after bariatric surgery may trigger 
      development of Barrett's oesophagus. Gastro-oesophageal reflux of bile is 
      captured by hepatobiliary iminodiacetic acid (HIDA) scintigraphy; however, 
      anatomical and physiological changes after bariatric surgery warrant protocol 
      modifications to optimise bile reflux detection. METHODS: HIDA scintigraphy 
      occurred 6 months after either sleeve gastrectomy, Roux-en-Y gastric bypass or 
      one-anastomosis gastric bypass. Standard HIDA scanning involves (i) 6-h fast and 
      24-h abstinence from opioids; (ii) IV administration of 99mTc di-isopropyl 
      iminodiacetic acid; and (iii) dual anterior/posterior 60-min dynamic scanning of 
      the duodenum, stomach and oesophagus. Three challenges were identified, and 
      modifications were implemented, namely, (1) anatomical localisation of refluxed 
      bile on planar scintigraphy was improved by adding a SPECT/CT for 3D imaging; (2) 
      impaired cholecystokinin-controlled gallbladder emptying, following bypassed 
      duodenum, was addressed by ingestion of a 'fatty meal'; and (3) intestinal 
      hypomotility after gastric bypass was counteracted by longer scan duration 
      (75-90 min) to allow bile to pass beyond the gastro-jejunal anastomosis. RESULTS: 
      HIDA scan was undertaken in 18 patients, 13 of whom underwent the modified 
      protocol. The tailored protocol ameliorated issues identified with the standard 
      HIDA scan protocol; thus, accurate anatomical localisation was achieved in all 
      patients, no delayed gallbladder emptying was observed, and bile was observed 
      beyond the gastro-jejunal anastomosis in all gastric bypass patients. The 
      modified technique was well tolerated by patients. CONCLUSION: A tailored HIDA 
      scan protocol with addition of a SPECT-CT scan, ingestion of a fatty meal and 
      prolonged scanning duration results in enhanced bile reflux detection in 
      post-bariatric surgical patients.
FAU - Eldredge, Thomas A
AU  - Eldredge TA
AUID- ORCID: 0000-0003-2439-7092
AD  - Discipline of Surgery, University of Adelaide, Adelaide, South Australia, 
      Australia. tom.andrew.eldredge@gmail.com.
AD  - Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South 
      Australia, Australia. tom.andrew.eldredge@gmail.com.
FAU - Bills, Madison
AU  - Bills M
AD  - Department of Nuclear Medicine, PET and Bone Densitometry, Royal Adelaide 
      Hospital and SA Medical Imaging, Adelaide, South Australia, Australia.
FAU - Myers, Jennifer C
AU  - Myers JC
AUID- ORCID: 0000-0003-2157-7098
AD  - Discipline of Surgery, University of Adelaide, Adelaide, South Australia, 
      Australia.
AD  - Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South 
      Australia, Australia.
FAU - Bartholomeusz, Dylan
AU  - Bartholomeusz D
AD  - Department of Nuclear Medicine, PET and Bone Densitometry, Royal Adelaide 
      Hospital and SA Medical Imaging, Adelaide, South Australia, Australia.
AD  - Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, South 
      Australia, Australia.
FAU - Kiroff, George K
AU  - Kiroff GK
AUID- ORCID: 0000-0003-0523-5311
AD  - Discipline of Surgery, University of Adelaide, Adelaide, South Australia, 
      Australia.
AD  - Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South 
      Australia, Australia.
FAU - Shenfine, Jonathan
AU  - Shenfine J
AUID- ORCID: 0000-0002-1862-4693
AD  - Discipline of Surgery, University of Adelaide, Adelaide, South Australia, 
      Australia.
AD  - Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, 
      Australia.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Obes Surg
JT  - Obesity surgery
JID - 9106714
RN  - 0 (Imino Acids)
RN  - XQM2L81M8Z (iminodiacetic acid)
SB  - IM
MH  - *Bariatric Surgery/adverse effects
MH  - *Bile Reflux/diagnostic imaging/etiology
MH  - Humans
MH  - Imino Acids
MH  - *Obesity, Morbid/surgery
MH  - Radionuclide Imaging
OTO - NOTNLM
OT  - Bile reflux
OT  - Gastric bypass
OT  - HIDA scintigraphy
OT  - Sleeve gastrectomy
EDAT- 2020/03/07 06:00
MHDA- 2021/04/15 06:00
CRDT- 2020/03/06 06:00
PHST- 2020/03/07 06:00 [pubmed]
PHST- 2021/04/15 06:00 [medline]
PHST- 2020/03/06 06:00 [entrez]
AID - 10.1007/s11695-020-04510-7 [pii]
AID - 10.1007/s11695-020-04510-7 [doi]
PST - ppublish
SO  - Obes Surg. 2020 May;30(5):2038-2045. doi: 10.1007/s11695-020-04510-7.