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Diagnosis of gastrogastric fistula on computed tomography: a quantitative approach

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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.

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, USA

    Guangzu Gao, Nariman Nezami, Mahan Mathur & Gary Israel

  2. Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, E/CC 4, Boston, MA, 02215, USA

    Patricia Balcacer

  3. Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, Tompkin’s East 2, PO Box 208042, New Haven, CT, 06520-8042, USA

    Michael Spektor

Authors
  1. Guangzu Gao
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  2. Nariman Nezami
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  3. Mahan Mathur
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  4. Patricia Balcacer
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  5. Gary Israel
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  6. Michael Spektor
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Corresponding author

Correspondence to Guangzu Gao.

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Conflict of interest

Guangzu Gao, M.D., Nariman Nezami, M.D., Mahan Mathur, M.D., Patricia Balcacer, M.D., Gary Israel, M.D., and Michael Spektor, M.D. declares that they have no conflict 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.

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Gao, G., Nezami, N., Mathur, M. et al. Diagnosis of gastrogastric fistula on computed tomography: a quantitative approach. Abdom Radiol 43, 1329–1333 (2018). https://doi.org/10.1007/s00261-017-1304-3

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  • DOI: https://doi.org/10.1007/s00261-017-1304-3

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