-
Abdominal Radiology (New York) Nov 2018The "gastrografin challenge" has been used for decades in the evaluation of small bowel obstruction (SBO). This type of study involves enteric administration of a... (Review)
Review
The "gastrografin challenge" has been used for decades in the evaluation of small bowel obstruction (SBO). This type of study involves enteric administration of a water-soluble contrast followed by serial abdominal radiographs. While its diagnostic role is well established, its therapeutic role remains controversial. Following an algorithm for gastrografin challenge cases can help with interpretation. An understanding of the appearance of diluted contrast in the small bowel, the concentrating effect of contrast in the colon, and knowledge of surgical history and anatomy is paramount for diagnosis. In this article, we review the approach to acute SBO and the use of gastrografin along with reviewing image interpretation of cases of partial and complete SBO. Gastrografin use in adynamic ileus along with other potential future uses is also discussed.
Topics: Algorithms; Contrast Media; Diagnosis, Differential; Diatrizoate Meglumine; Humans; Intestinal Obstruction; Intestine, Small; Radiography, Abdominal
PubMed: 29632988
DOI: 10.1007/s00261-018-1591-3 -
Neurogastroenterology and Motility May 2021Postoperative ileus is common and is a major clinical problem. It has been widely studied in patients and in experimental models in laboratory animals. A wide variety of... (Review)
Review
BACKGROUND
Postoperative ileus is common and is a major clinical problem. It has been widely studied in patients and in experimental models in laboratory animals. A wide variety of treatments have been tested to prevent or modify the course of this disorder.
PURPOSE
This review draws together information on animal studies of ileus with studies on human patients. It summarizes some of the conceptual advances made in understanding the mechanisms that underlie paralytic ileus. The treatments that have been tested in human subjects (both pharmacological and non-pharmacological) and their efficacy are summarized and graded consistent with current clinical guidelines. The review is not intended to provide a comprehensive overview of ileus, but rather a general understanding of the major clinical problems associated with it, how animal models have been useful to elucidate key mechanisms and, finally, some perspectives from both scientists and clinicians as to how we may move forward with this debilitating yet common condition.
Topics: Anesthesia, Epidural; Animals; Benzofurans; Chewing Gum; Cholinergic Agents; Contrast Media; Cyclooxygenase Inhibitors; Diatrizoate Meglumine; Digestive System Surgical Procedures; Enhanced Recovery After Surgery; Enteral Nutrition; Enteric Nervous System; Fluid Therapy; Gastrointestinal Agents; Gastrointestinal Motility; Ghrelin; Humans; Ileus; Inflammation; Intestinal Pseudo-Obstruction; Intubation, Gastrointestinal; Laparoscopy; Mast Cells; Piperidines; Postoperative Complications; Serotonin 5-HT4 Receptor Agonists; Sympathetic Nervous System; Sympatholytics
PubMed: 33252179
DOI: 10.1111/nmo.14046 -
Surgery For Obesity and Related... Sep 2020Laparoscopic sleeve gastrectomy (LSG) has become increasingly popular in bariatric surgery. However, in the long-term follow-up, weight loss failure and intractable...
BACKGROUND
Laparoscopic sleeve gastrectomy (LSG) has become increasingly popular in bariatric surgery. However, in the long-term follow-up, weight loss failure and intractable severe acid reflux after primary LSG can necessitate further interventions.
OBJECTIVES
The aim of our study was to evaluate long-term results 5 years after resleeve gastrectomy (ReSG).
SETTING
Private hospital, France.
METHODS
The study included all patients with failure after LSG who underwent ReSG between October 2008 and January 2014. The patients underwent radiologic evaluation, and an algorithm of treatment was proposed. We analyzed the 5-year outcomes concerning weight loss and long-term complications after ReSG.
RESULTS
A total of 52 patients (46 women; mean age 40.2 yr) with a mean body mass index (BMI) of 39.4 kg/m underwent ReSG. The mean interval time from the primary LSG to ReSG was of 27.8 months (11-72 mo). The indication for ReSG was inadequate weight loss (28 patients; 53.8%), weight regain (22 patients; 42.3%), and gastroesophageal reflux disease (2 patients; 3.8%). In 35 cases the contrast agent (diatrizoate meglumine/diatrizoate sodium solution [Gastrografin]) swallow results were interpreted as primary dilation and in the remaining 17 cases as secondary dilation. One patient died from gynecologic cancer. Of the remainder, 3 patients underwent single-anastomosis duodenoileal bypass, 5 patients underwent Roux-en-Y gastric bypass, and 1 patient underwent a second ReSG for reflux. A total of 39 of 42 patients with ReSG as definitive procedure had available data at 5-year follow-up. The mean percentage of excess BMI loss was 63.7%. Of the 39 patients, 28 (71.8%) had >50% excess BMI loss at 5 years. Eight of the 11 patients with weight loss failure (<50% excess BMI loss) after ReSG were diagnosed with secondary or diffuse dilation on preoperative imaging; the remaining 3 patients had been operated in our early initial experience with the resleeve procedure. All cases were completed by laparoscopy with no intraoperative incidents. In terms of complications, we recorded 1 leak, 2 stenoses, and 2 cases of bleeding with no mortality.
CONCLUSIONS
At 5 years postoperative, the ReSG as a definitive bariatric procedure remained effective for 53.8%. The results appear to be more favorable especially for the non-super-obese patients and for those with primary dilation. ReSG is a well-tolerated bariatric procedure with a low long-term complication rate. Further prospective clinical trials are required to compare the outcomes of ReSG with those of Roux-en-Y gastric bypass or single-anastomosis duodenoileal bypass for weight loss failure after LSG.
Topics: Adult; Body Mass Index; Female; France; Gastrectomy; Gastric Bypass; Humans; Laparoscopy; Obesity, Morbid; Reoperation; Retrospective Studies; Treatment Outcome
PubMed: 32580923
DOI: 10.1016/j.soard.2020.04.021 -
The Ocular Surface Jul 2014Autologous transplantation of submandibular gland (SMG) is effective for severe keratoconjunctivitis sicca (KCS). Sialography is a method for morphological evaluation of... (Review)
Review
Autologous transplantation of submandibular gland (SMG) is effective for severe keratoconjunctivitis sicca (KCS). Sialography is a method for morphological evaluation of the transplanted gland.We recruited 15 patients (15 eyes) with severe KCS who had successfully undergone SMG transplantation. Thirteen patients had normal transplanted SMGs, while two patients were suspected to have obstructive sialadenitis of the transplanted SMG. Sialography was performed in each patient with meglumine diatrizoate. Projections were applied immediately and 5, 7, and 10 min after contrast injection. The median dose of the contrast medium was 0.9 ml (range, 0.7-1.1 ml) for the full-size transplanted SMGs and 0.5 ml for the glands after reduction surgery. The acini and the ducts were clearly visible on sialograms. The contrast medium was completely excreted in 10 min in normal transplanted SMGs. The main duct had a regular shape in normal transplanted SMGs, while irregular dilation and stricture of the duct with delayed excretion of the contrast medium were found in the glands with obstructive sialadenitis. In conclusion, sialography is clinically feasible and valuable for the morphological evaluation of the transplanted SMG.
Topics: Humans; Keratoconjunctivitis Sicca; Reproducibility of Results; Sialography; Submandibular Gland; Transplantation, Autologous
PubMed: 24999103
DOI: 10.1016/j.jtos.2014.02.005 -
Annals of Translational Medicine Mar 2020Contrast induced diabetic nephropathy (CIN) is an important cause of hospital-acquired acute renal failure. Our aim was to observe the effect of protein kinase C β2...
BACKGROUND
Contrast induced diabetic nephropathy (CIN) is an important cause of hospital-acquired acute renal failure. Our aim was to observe the effect of protein kinase C β2 (PKCβ2) knockdown on human proximal tubular epithelial cells (HK-2 cells) against meglumine diatrizoate and advanced glycation end products (AGEs)-induced apoptosis and autophagy.
METHODS
Cell viability was detected using cell counting kit-8 (CCK-8) assay in HK-2 cells after disposal with meglumine diatrizoate and AGEs with or without PKCβ2 siRNA/inhibitor LY333531. Flow cytometry and western blot were used to test cell apoptosis and the related protein levels in meglumine diatrizoate and AGEs co-treated HK-2 cells with or without PKCβ2 siRNA/inhibitor LY333531. Autophagy related proteins were detected using western blot. Immunofluorescence staining was used to examine the autophagy-specific protein light chain 3 (LC3), and autophagosome and autolysosome formation was observed under a transmission electron microscopy.
RESULTS
CCK-8 assay results showed that meglumine diatrizoate inhibited AGEs-induced HK-2 cell viability. Furthermore, meglumine diatrizoate promoted cell apoptosis and the expression level of caspase3 in AGEs-induced HK-2. Western blot results showed that meglumine diatrizoate elevated the expression levels of PKCβ2 and p-PKCβ2 in AGEs-induced HK-2 cells, and up-regulated the expression level of Beclin-1 and the ratio of LC3 II/LC3 I, and down-regulated the expression level of p62 in AGEs-induced HK-2 cells. We found that PKCβ2 knockdown alleviated meglumine diatrizoate and AGEs-induced HK-2 cell apoptosis and autophagy. Intriguingly, PKCβ2 inhibitor LY333531 reversed 3-methyladenine (3-MA)-induced autophagy inhibition in meglumine diatrizoate and AGEs-induced HK-2 cells.
CONCLUSIONS
Our findings reveal that inhibiting PKCβ2 protects HK-2 cells against meglumine diatrizoate and AGEs-induced apoptosis and autophagy, which provide a novel therapeutic insight for CIN in diabetic patients.
PubMed: 32355737
DOI: 10.21037/atm.2020.02.172 -
European Radiology Aug 2020Esophageal peroral endoscopic myotomy (POEM) is the treatment of reference of major obstructive esophageal motility disorders but the detection of early complications...
Meglumine diatrizoate esophagogram after peroral endoscopic myotomy (POEM): identification of imaging findings associated with clinical complications and longer hospital stay.
OBJECTIVES
Esophageal peroral endoscopic myotomy (POEM) is the treatment of reference of major obstructive esophageal motility disorders but the detection of early complications remains challenging. Our aim was to report the radiological findings on meglumine diatrizoate esophagograms after esophageal POEM and identify variables associated with patient outcomes.
METHODS
The imaging and clinical files of 106 patients who underwent POEM for achalasia or other major obstructive esophageal motility disorders were retrospectively analyzed. Post POEM esophagograms were reviewed for the presence of pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips. Associations between length of hospital stay and radiological findings were searched for using a Cox multivariate analysis.
RESULTS
A total of 106 patients (M/F = 56/50; mean age = 50 ± 2 [SD] years) underwent 106 POEM procedures with a meglumine diatrizoate esophagogram on postoperative day 1. Overall median hospital stay was 3 days (range 1-20 days). Pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips were observed in 90/106 (84.9%), 12/106 (11.3%), 4/106 (3.8%), and 0/106 (0%) patients, respectively. At multivariate analysis, pleural effusion (p = 0.005; adjusted hazard ratio [aHR] = 0.35 [95% CI 0.17-0.73]) and extraesophageal contrast leakage (p = 0.039; aHR = 0.27 [95% CI 0.08-0.94]) were associated with a prolonged hospital stay. Pneumoperitoneum was not associated with unfavorable outcome (p = 0.99).
CONCLUSIONS
Pneumoperitoneum is a common finding after POEM and is not indicative of unfavorable patient outcome. Conversely, post POEM pleural effusion and extraesophageal contrast leakage are associated with a longer hospital stay.
KEY POINTS
• Water-soluble esophagogram is a valid diagnostic modality to diagnose early complications after esophageal endoscopic myotomy for esophageal motility disorders. • At multivariate analysis, pleural effusion and extraesophageal contrast leakage are associated with a prolonged hospital stay after peroral endoscopic myotomy. • Pneumoperitoneum is not associated with unfavorable outcome after peroral endoscopic myotomy.
Topics: Adult; Aged; Contrast Media; Diatrizoate Meglumine; Esophageal Achalasia; Esophageal Motility Disorders; Esophagus; Female; Humans; Length of Stay; Male; Middle Aged; Myotomy; Natural Orifice Endoscopic Surgery; Pneumoperitoneum; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 32170414
DOI: 10.1007/s00330-020-06758-0 -
Biotechnology & Genetic Engineering... Mar 2023After emergency surgery for intestinal obstruction caused by colorectal cancer, postoperative ileus (POI) is more likely to occur in the early-stage oral intake. POI...
UNLABELLED
After emergency surgery for intestinal obstruction caused by colorectal cancer, postoperative ileus (POI) is more likely to occur in the early-stage oral intake. POI incited the occurrence of postoperative complications and prolongs hospital stay. Reducing the occurrence of POI will Enhance Recovery After Surgery (ERAS).
AIM
The aim of this study is to observe and evaluate the preventive effect of postoperative oral administration of 76% Meglumine Diatrizoate in reducing the incidence of POI and promoting intestinal absorption during the recovery of intestinal peristalsis in patients after intestinal obstruction surgery.
METHODS
From October 2018 to December 2021, 94 patients (47 vs 47) with intestinalobstruction were rolled. Patients with an ASA score of 4 or higher and gastrointestinal perforation with peritonitis were excluded. After 24 hours of surgery, the patients were divided into experimental group and control group disposed of with an opaque airtight envelope method, patient-side single blind. After intestinal peristalsis recovery (2.45 ± 0.62 d vs 2.60 ± 0.68 d, > 0.05), the experimental group was given 76% Meglumine Diatrizoate 20 ml orally 9am and the control group was given 10% glucose 20 ml for three consecutive days. POI cases, the time taken to achieve full daily oral calorie and discharge days were counted.
RESULTS
The time required to achieve full daily oral calorie (11.04 ± 2.70 d vs 14.09 ± 3.74 d, < 0.05), POI cases (10/47 vs 20/47, < 0.05) and discharge days (14.00 ± 4.89 d vs 16.77 ± 5.94 d, < 0.05) are significantly different between the two groups.
CONCLUSIONS
Oral 76% Meglumine Diatrizoate is safe and effective, which can reduce the occurrence of POI, promote the recovery of intestinal absorption and shorten the length of hospital stay effectively.
PubMed: 36966379
DOI: 10.1080/02648725.2023.2191083 -
Advances in Pediatrics Aug 2022Adhesive small bowel obstructions are a common cause of morbidity in children who underwent prior abdominal surgery. The concept of partial versus complete bowel... (Review)
Review
Adhesive small bowel obstructions are a common cause of morbidity in children who underwent prior abdominal surgery. The concept of partial versus complete bowel obstruction is outdated and lacks precision to be clinically useful. Identifying patients with indications for immediate operative intervention is critical and must be recognized to limit morbidity. Clinical protocols and contrast challenge algorithms have attempted to identify patients that will resolve their bowel obstruction nonoperatively; there has been slow uptake in the pediatric patient population versus adults until recently. Incorporating predictive models and standardized contrast challenge protocols will help reduce interpractitioner variability and improve clinical outcomes.
Topics: Adhesives; Adult; Child; Contrast Media; Diatrizoate Meglumine; Humans; Intestinal Obstruction; Tissue Adhesions; Treatment Outcome
PubMed: 35985714
DOI: 10.1016/j.yapd.2022.03.002 -
Radiography (London, England : 1995) Nov 2020To investigate the impact of two Meglumine-Diatrizoate based bowel preparation regimes for computed tomography colonography (CTC) on the patient experience and image...
INTRODUCTION
To investigate the impact of two Meglumine-Diatrizoate based bowel preparation regimes for computed tomography colonography (CTC) on the patient experience and image quality.
METHODS
100 patients consumed Meglumine-Diatrizoate at 24 h and 12 h prior to the CTC examination. 50 patients followed regime 1 (50:50), 50 ml of Meglumine-Diatrizoate at both 24 and 12 h prior to the examination. 50 patients followed regime 2 (75:25), 75 ml of Meglumine-Diatrizoate at 24 h prior to the examination and 25 ml of Meglumine-Diatrizoate at 12 h prior to the examination. All patients completed a questionnaire to indicate the time of onset of adverse effects and when they were most severe. Five advanced practitioners assessed the image quality in a visual grading study. Visual grading characteristic (VGC) analysis was applied with regime 1 as the reference condition and regime 2 and test condition; test alpha was set at 0.05.
RESULTS
Image quality was assessed with successful bowel cleansing as the scoring criteria for the visual grading study. The bowel cleansing as provided by the two Meglumine-Diatrizoate regimes was revealed not to be statistically different, with the area under the VGC curve and 95% confidence intervals 0.487 (0.287, 0.701), p = 0.887. Patients taking the 75:25 bowel preparation experienced a shorter median time to the onset of adverse effects.
CONCLUSION
There was no observed difference in Image quality criteria score for the two Meglumine-Diatrizoate based bowel preparation with more predictable adverse effects of Meglumine-Diatrizoate with the 75:25 preparation.
IMPLICATIONS FOR PRACTICE
Providing patients with a higher contrast burden 24 h prior to CTC may have a positive impact on the patient experience without compromising image quality.
Topics: Cathartics; Colonography, Computed Tomographic; Contrast Media; Diatrizoate Meglumine; Humans; Tomography
PubMed: 32376192
DOI: 10.1016/j.radi.2020.04.007 -
The British Journal of Radiology Feb 2022With optimized technique, the water-soluble contrast challenge is effective at triaging patients for operative non-operative management of suspected small bowel... (Review)
Review
With optimized technique, the water-soluble contrast challenge is effective at triaging patients for operative non-operative management of suspected small bowel obstruction. Standardized study structure and interpretation guidelines aid in clinical efficacy and ease of use. Many tips and tricks exist regarding technique and interpretation, and their understanding may assist the interpreting radiologist. In the future, a CT-based water-soluble contrast challenge, utilizing oral contrast given as part of the initial CT examination, might allow for a more streamlined algorithm and provide more rapid results.
Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Algorithms; Colon; Conservative Treatment; Contrast Media; Diatrizoate Meglumine; Gastrointestinal Transit; Humans; Intestinal Obstruction; Intestine, Small; Intubation, Gastrointestinal; Iohexol; Middle Aged; Radiography, Abdominal; Treatment Outcome; Triage
PubMed: 34826227
DOI: 10.1259/bjr.20210791