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Diagnostic accuracy of abdominal contrast-enhanced multi-slice spiral CT after oral diluted iodide in a time segment for gastrointestinal fistula in patients with severe acute pancreatitis

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Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the diagnostic accuracy of abdominal contrast-enhanced multi-slice spiral CT after oral diluted iodide in a time segment (post-ODI ACE-MSCT) for gastrointestinal fistula (GIF) in severe acute pancreatitis (SAP).

Materials and methods

Patients with SAP who underwent both post-ODI ACE-MSCT and endoscopy/surgery from 2017 to 2023 were continuously retrospectively involved. Their demographic information and clinical features were recorded prospectively in an in-hospital database. Using endoscopy/surgery results as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of post-ODI ACE-MSCT for diagnosing GIF in SAP were calculated by a four-cell table. The consistency of the two diagnostic methods was evaluated by the Kappa test and McNemar’s test.

Results

Using endoscopy/surgery as the reference standard, a total of 86 cases were divided into the GIF group (N = 52) and the non-GIF group (N = 34). Among the 52 cases of GIF, 88.5% (46/52) cases had a positive result and 11.5% (5/52) cases had a negative result of post-ODI ACE-MSCT for GIF. Among the 34 cases of non-GIF, 2.9% (1/34) case had a positive result and 97.1% (33/34) cases had a negative result of post-ODI ACE-MSCT for GIF. Post-ODI ACE-MSCT had a sensitivity of 88.5% (95% CI 75.9%–95.2%), a specificity of 97.1% (95% CI 82.9%–99.8%), a positive predictive value of 97.9% (95% CI 87.3%–99.9%), a negative predictive value of 84.6% (95% CI 68.8%–93.6%), and an accuracy of 91.9% (83.4%–96.4%). The kappa value was 0.834, and P < 0.001 by McNemar’s test. There were no significant differences in diagnostic test characteristics between the two modalities.

Conclusion

Post-ODI ACE-MSCT can diagnose GIF in SAP in a simple, noninvasive, and accurate way, and can provide earlier imaging evidence for clinical diagnosis and treatment.

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References

  1. Boxhoorn L, van Dijk SM, van Grinsven J, Verdonk RC, Boermeester MA, Bollen TL, et al. Immediate versus postponed intervention for infected necrotizing pancreatitis. N Engl J Med. 2021;385(15):1372–81.

    Article  PubMed  Google Scholar 

  2. Barreto SG, Kaambwa B, Venkatesh K, Sasson SC, Andersen C, Delaney A, et al. Mortality and costs related to severe acute pancreatitis in the intensive care units of Australia and New Zealand (ANZ), 2003–2020. Pancreatology. 2023;23(4):341–9.

    Article  PubMed  Google Scholar 

  3. Gilna GP, Saberi RA, Ramsey W, Huerta CT, O’Neil CF, Perez EA, et al. Outcomes of abdominal firearm injury and damage control laparotomy in the pediatric population. J Surg Res. 2022;279:733–8.

    Article  PubMed  Google Scholar 

  4. Ke L, Zhou J, Mao W, Chen T, Zhu Y, Pan X, et al. Immune enhancement in patients with predicted severe acute necrotising pancreatitis: a multicentre double-blind randomised controlled trial. Intensive Care Med. 2022;48(7):899–909.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Gao L, Zhang JZ, Gao K, Zhou J, Li G, Li BQ, et al. Management of colonic fistulas in patients with infected pancreatic necrosis being treated with a step-up approach. HPB (Oxford). 2020;22(12):1738–44.

    Article  PubMed  Google Scholar 

  6. Kammerer S, Schuelke C, Berkemeyer S, Velasco A, Heindel W, Koehler M, et al. The role of multislice computed tomography (MSCT) angiography in the diagnosis and therapy of non-occlusive mesenteric ischemia (NOMI): could MSCT replace DSA in diagnosis? PLoS ONE. 2018;13(3):e0193698.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Li GM, Zhou H, Liang MY, Wu SY, Jiang FX, Wang ZL. Diagnostic role of multislice spiral computed tomography combined with clinical manifestations and laboratory tests in acute appendicitis subtypes. J Investig Med. 2023;71(1):17–22.

    Article  PubMed  Google Scholar 

  8. Li H, Mo Y, Huang C, Ren Q, Xia X, Nan X, et al. An MSCT-based radiomics nomogram combined with clinical factors can identify Crohn’s disease and ulcerative colitis. Ann Transl Med. 2021;9(7):572.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Gao X, Hua Y, Meng H, Dong L, Zhang L, Jiang X, et al. The value of MSCT in evaluating the passability of bezoar by conservative treatment for bezoars-induced small bowel obstruction. Abdom Radiol (NY). 2023;48(1):236–43.

    Article  PubMed  Google Scholar 

  10. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11.

    Article  PubMed  Google Scholar 

  11. Wu X, Wu J, Wang P, Fang X, Yu Y, Tang J, et al. Diagnosis and management of intraabdominal infection: guidelines by the chinese society of surgical infection and intensive care and the chinese college of gastrointestinal fistula surgeons. Clin Infect Dis. 2020;71(Suppl 4):S337-s362.

    Article  PubMed  Google Scholar 

  12. Agarwala R, Rana SS, Sharma R, Kang M, Gorsi U, Gupta R. Gastrointestinal failure is a predictor of poor outcome in patients with acute pancreatitis. Dig Dis Sci. 2020;65(8):2419–26.

    Article  CAS  PubMed  Google Scholar 

  13. Peng Y, Fang C, Zhu G, Peng F, Tian J, Su S, et al. Preliminary application of indocyanine green fluorescence imaging in postoperative gastrointestinal fistula. Photodiagnosis Photodyn Ther. 2021;34:102336.

    Article  CAS  PubMed  Google Scholar 

  14. Bansal A, Gupta P, Singh H, Samanta J, Mandavdhare H, Sharma V, et al. Gastrointestinal complications in acute and chronic pancreatitis. JGH Open. 2019;3(6):450–5.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gupta P, Chayan Das G, Sharma V, Mandavdhare H, Samanta J, Singh H, et al. Role of computed tomography in prediction of gastrointestinal fistula in patients with acute pancreatitis. Acta Gastroenterol Belg. 2019;82(4):495–500.

    CAS  PubMed  Google Scholar 

  16. Dolan RD, Bazarbashi AN, Jirapinyo P, Thompson CC. Test characteristics of abdominal computed tomography for the diagnosis of gastro-gastric fistula in patients with roux-en-y gastric bypass. Obes Surg. 2021;31(6):2471–6.

    Article  PubMed  Google Scholar 

  17. Timmerhuis HC, van Dijk SM, Hollemans RA, Umans DS, Sperna Weiland CJ, Besselink MG, et al. Perforation and fistula of the gastrointestinal tract in patients with necrotizing pancreatitis: a nationwide prospective cohort. Ann Surg. 2023;278(2):e284–92.

    Article  PubMed  Google Scholar 

  18. Hua Z, Su Y, Huang X, Zhang K, Yin Z, Wang X, et al. Analysis of risk factors related to gastrointestinal fistula in patients with severe acute pancreatitis: a retrospective study of 344 cases in a single Chinese center. BMC Gastroenterol. 2017;17(1):29.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Li G, Yang J, Huang MF, Ye B, Zhou J, Diao Q, et al. Involvement of transverse mesocolon is associated with development of colonic fistula in patients with acute necrotizing pancreatitis. Pancreatology. 2023;23(3):314–20.

    Article  PubMed  Google Scholar 

  20. Nakanishi N, Shimono T, Yamamoto A, Miki Y. CT evaluation and clinical factors predicting delayed colonic perforation following acute pancreatitis. Jpn J Radiol. 2016;34(1):10–5.

    Article  PubMed  Google Scholar 

  21. Llueca A, Serra A, Climent MT, Maiocchi K, Villarin A, Delgado K, et al. Postoperative intestinal fistula in primary advanced ovarian cancer surgery. Cancer Manag Res. 2021;13:13–23.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wang K, Dong SS, Zhang W, Ni YY, Xie F, Wang JC, et al. Surgical methods influence on the risk of anastomotic fistula after pancreaticoduodenectomy: a systematic review and network meta-analysis. Surg Endosc. 2023;37(5):3380–97.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This study was supported by Scientific Research Project of Education Department of Hunan Province (No. 21C0024).

Funding

This study was supported by Scientific Research Project of Education Department of Hunan Province (No. 21C0024).

Author information

Authors and Affiliations

  1. Department of Critical Care Medicine, Hunan Provincial People’s Hospital (The First-Affiliated Hospital of Hunan Normal University), 61 Jiefang West Road, Changsha, 410005, Hunan, China

    Li Huang

  2. Department of Radiology, Hunan Provincial People’s Hospital (The First-Affiliated Hospital of Hunan Normal University), 61 Jiefang West Road, Changsha, 410005, Hunan, China

    Guang Zhou

  3. Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First-Affiliated Hospital of Hunan Normal University), 61 Jiefang West Road, Changsha, 410005, Hunan, China

    Xi-tao Wang & Guo-guang Li

  4. Department of General Surgery, Hunan Provincial People’s Hospital (The First-Affiliated Hospital of Hunan Normal University), 61 Jiefang West Road, Changsha, 410005, Hunan, China

    Guang-yi Li

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  1. Li Huang
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  2. Guang Zhou
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Contributions

HL: conceptualization, data creation, investigation, statistical analysis and writing original draft. ZG, WX-t: writing review and editing. LG-g: supervision. LG-y: resources.

Corresponding author

Correspondence to Guo-guang Li.

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Conflict of interest

All authors have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by our institutional ethical review board. Informed consent was waived for this retrospective study.

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Huang, L., Zhou, G., Wang, Xt. et al. Diagnostic accuracy of abdominal contrast-enhanced multi-slice spiral CT after oral diluted iodide in a time segment for gastrointestinal fistula in patients with severe acute pancreatitis. Jpn J Radiol (2024). https://doi.org/10.1007/s11604-024-01540-4

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