The Role of Conventional Ultrasonography in the Evaluation of Antrum Wall Thickness in Obese Patients

Efficacy of B - mode and elastography ultrasound technique in the prediction of Helicobacter pylori: a prospective study

BACKGROUND

Helicobacter pylori (HP) affect nearly 50% of the world's population and can colonize the submucosal and mucosal layers of the stomach wall, causing inflammation leading to a thickening of these layers. The study aimed to evaluate the application value of transabdominal ultrasonography combined with elastography in the prediction of HP using HP Fecal Antigen Test as gold standard.

METHOD

This prospective case-control study was conducted in 174 participants classified into three groups: Group A: Symptomatic patients with thickened stomach antral and evident HP infection on fecal antigen test results, Group B: Symptomatic patients with thickened antral and no evident HP infection on fecal antigen test results, and Group C: control group of asymptomatic individuals with negative HP screening to predict the diagnostic accuracy of B-mode ultrasound and elastography in the prediction of HP pylori.

RESULTS

Positive HP patients had higher values of antral wall thickness (AWT), mucosal layer thickness (MLT), MLT/AWT ratio, SR (strain ratio), and a combination of AWT and SR: 5.57 ± 0.55 mm, 2.96 ± 0.45 mm, 0.53 ± 0.06 mm, 3.21 ± 0.43, and 8.79 ± 0.68 mm, respectively. In comparison, negative HP patients had values of 4.61 ± 0.47 mm, 2.05 ± 0.42 mm, 0.41 ± 0.08 mm, 2.51 ± 0.42 mm, and 7.13 ± 0.62 mm, respectively, and the control groups had values of 3.53 ± 0.36 mm, 1.47 ± 0.25 mm, 0.40 ± 0.06 mm, 1.81 ± 0.41, and 5.35 ± 0.55 mm, respectively (p < 0.001). The sensitivity of B-mode ultrasonography, elastography, and the combination of the two was 98%, 95.1%, and 98.4%, respectively, and the diagnostic accuracy was 98.4%, 98.3%, and 100%, respectively.

CONCLUSION

B-mode ultrasonography and elastography exhibit high discriminatory power in distinguishing symptomatic HP patients from normal individuals and differentiating + HP from - HP, with greater discriminatory power when combined both modes.

Impact of Helicobacter pylori Status on Postoperative Morbidities After Laparoscopic Sleeve Gastrectomy in an Endemic Region (a Retrospective Multicentric Study)

PURPOSE

Studies are still ongoing to determine whether Helicobacter pylori (HP) may affect the results of laparoscopic sleeve gastrectomy (LSG). The main research objectives were HP prevalence in patients with severe obesity and the effects of HP status on outcomes.

PATIENTS AND METHODS

This multicenter retrospective study included patients with severe obesity who had LSG. The patients were grouped into three groups based on the HP status of preoperative endoscopic biopsies and postoperative specimen results: group I (negative HP), group II (eradicated HP), and group III (positive HP). The primary outcome was the overall postoperative morbidities.

RESULTS

One thousand six hundred fifteen patients who underwent LSG for severe obesity were included in this study. Seven hundred fifty (46.4%) patients had negative HP, and 637 (39.4%) patients had eradicated HP, whereas 228 (14.1%) patients had positive HP. The antral and gastric body wall thickness was significantly noticed with positive HP. The groups had no significant differences regarding postoperative complication frequency, severity, and hospital mortality. The rates of gastric leakage in the three groups do not differ significantly. BMI > 50, gastropexy, gastric thickness, and antral resection were found to be independent risk factors for the occurrence of postoperative complications after LSG. There was no statistical significance as regards postoperative %TWL and %EWL among the three groups.

CONCLUSION

The early results of LSG do not appear to be impacted by HP's status. The early postoperative course is unaffected by HP eradication anymore. Therefore, routine preoperative HP testing may not be as necessary, and management can be finished after LSG.

Risk stratification of gastric cancer screening in community population based on oral contrast-enhanced ultrasonography examination: A 3-year follow-up analysis report

Objective

This study aimed to retrospectively investigate the use of oral contrast-enhanced ultrasonography (O-CEUS) in assessing the thickness of the gastric wall for gastric cancer (GC) screening and to establish screening strategies for GC with different risk stratifications based on the gastric wall thickness.

Methods

From January 2015 to March 2020, people who underwent O-CEUS at the Physical Examination Center of our hospital with at least three years of follow-up were included in this study. The thickness of the gastric wall measured by O-CEUS was divided into three groups using 6 mm and 9 mm as cutoff values. The occurrence of GC in each group was observed. The imaging and clinical information of these populations were recorded and analyzed. Kaplan-Meier survival analysis and Cox's proportional hazards regression were performed to calculate the risk of GC occurrence.

Results

A total of 4,047 people were finally included in this study. During the follow-up period, GC occurred in 7 individuals (incidence rate 0.17%). Among them, according to the thickness of the gastric wall, one case occurred in Group A (< 6 mm), two cases occurred in Group B (6-9 mm), and four cases occurred in Group C (>9mm). Based on Kaplan-Meier survival analysis, the curves of the three groups were significantly different (P < 0.01). The risk of GC occurrence in Group C and Group B were higher than that in Group A (4.76E+2-fold and 1.50E+2-fold).

Conclusion

O-CEUS is a convenient, economical, safe, and noninvasive screening method for GC. Measuring the thickness of the gastric wall is helpful to predict the risk of GC occurrence according to our stratification screening system.

Measurement of gastric wall thickness after laparoscopic sleeve gastrectomy: obesity comorbidities and gastric wall in Chinese patients with obesity

Leakage of the sleeve remains constant after laparoscopic sleeve gastrectomy (LSG). This complication may be due to a mismatch between the staple height and gastric wall thickness (GWT). Our aim was to measure the GWT in Chinese patients with obesity and investigate the relationship between GWT and gender, body mass index (BMI), body weight, and obesity-related comorbidities. The GWT of 210 resected specimens after LSG was measured using a tissue measuring device, at a compression pressure of 8 g/mm² at three predetermined locations: antrum, midbody, and fundus. Two hundred ten patients (171 female/39 male). The gastric wall was thickest at the antrum followed by the midbody and thinnest at the fundus (3.02 mm, 2.22 mm, and 1.6 mm, respectively). Patients with gastritis and those with reflux esophagitis had thicker GWT at the antrum; male had thicker GWT at the antrum and fundus; patients with body weight > 100 kg, and those with BMI > 40 kg/m² had thicker GWT at the fundus. Linear regression analysis revealed a significant association between GWT with body weight and BMI at the antrum and fundus; Furthermore, hypertension associated with the GWT at the fundus (P < 0.01, P < 0.01, P < 0.02, P < 0.01; and P < 0.04, respectively). This study showed that the anatomical location of the gastric wall is a major predicting factor of GWT. Furthermore, gastritis, reflux esophagitis, male gender, BMI > 40 kg/m², body weight > 100 kg, and hypertension may increase the GWT at the antrum and fundus in Chinese patients with obesity.

Gastric Wall Thickness and Linear Staple Height in Sleeve Gastrectomy in Japanese Patients with Obesity

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is a standard procedure due to its low complication rates and favorable outcomes. However, limited data are available regarding the optimal size of linear staplers in relation to gastric wall thickness (GWT).

METHODS

Between August 2016 and December 2020, we performed LSG in 70 patients with an average age, body weight, and body mass index of 42 years, 107 kg, and 40 kg/m², respectively. We measured the GWT at the antrum, body, and fundus using resected specimens. We used an endo-linear stapler, and the closed staple height (CSH) was 1.75 mm.

RESULTS

We found that the average GWT at the antrum was significantly thicker than the GWT at the body and fundus. There was a statistically significant relationship between body weight and the GWT at the antrum and body and obstructive sleep apnea and the GWT at the body. The average CSH/GWT ratios were 0.55, 0.62, and 0.90 at the antrum, body, and fundus, respectively. However, in 20 patients (29%), the CSH/GWT ratio at the fundus area was ≥ 1.0, and only preoperative body weight was a significant predictor for a CSH/GWT ratio of ≥ 1.0.

CONCLUSION

A light body weight may be related to a CSH/GWT ratio of ≥ 1.0 at the fundus.

Gastric Balloon Implantation as Part of Morbid Adiposity Therapy Changes the Structure of the Stomach Wall

PURPOSE

The implantation of a gastric balloon (also known as intragastric balloon) is an established and reversible endoscopic procedure for adiposity therapy. Structural changes of the stomach wall are expected to occur with gastric balloon implantation; however, until now these changes have rarely been investigated.

METHODS

We compared the histological structure of the stomach wall after gastric-sleeve resection in a group of patients following gastric balloon implantation and a group without previous gastric balloon implantation.

RESULTS

Following gastric balloon implantation, the tunica muscularis was found to be significantly thicker than without gastric balloon implantation. The enlarging of the tunica muscularis is not caused by hyperplasia of the leiomyocytes, but by hypertrophy of the leiomyocytes and an increase in collagen fibers (fibrosis).

CONCLUSION

A longer-lasting hypertrophy of the tunica muscularis, particularly in the corpus, should be taken into account when surgical treatment follows gastric balloon implantation. The staple suture height should be adjusted to the altered tissue composition since reduced tissue elasticity must be expected due to fibrosis.

The Effect of Helicobacter pylori Eradication on Gastric Wall Thickness in Patients Undergoing Laparoscopic Sleeve Gastrectomy

PURPOSE

The most important cause affecting the thickness of the gastric wall other than the tumor is chronic gastritis caused by Helicobacter pylori (Hp), which is most frequently detected in the antrum. This study aims to investigate the effect of bismuth-based treatment (BBT) combined with proton pump inhibitor (PPI) on wall thicknesses measured in the postoperative gastric specimen and early postoperative complications in patients with Hp-positive pre-LSG endoscopic gastric biopsies.

MATERIALS AND METHODS

The patients who underwent LSG procedure for morbid obesity were divided into three groups as follows: Hp-negative, Hp-positive without eradication treatment, and Hp-positive, and LSG was performed after eradication treatment. Macroscopic and microscopic gastric wall thickness measurements were made at a distance of 1 cm from the proximal surgical margin, from the middle part of the specimen, and 1 cm from the distal surgical margin in the gastric specimen and the results were compared.

RESULTS

A total of 132 patients were included in the study, 44 patients in each group. Microscopically measured antrum mucosal thickness was found to be statistically significantly higher in group 2 compared to other groups (groups 1.15, 1.35, 1.16 mm, respectively, p = 0.000). There was no difference between the groups in terms of early complications such as bleeding, wound site infection, or leakage from the staple line within the first 28 days after surgery.

CONCLUSION

This study found that LSG had no effect on early complications due to Hp positivity or eradication of Hp.

KEY POINTS

• The presence of HP increases the wall thickness of the gastric antrum mucosa. • After HP eradication, stomach antrum wall thickness returns to normal. • HP eradication before LSG reduces the wall thickness of the gastric antrum mucosa. • It was determined that HP scanning and eradication before LSG had no effect on postoperative complications.

Gastritis might be considered as a technical factor affecting laparoscopic sleeve gastrectomy

There is a paucity of data regarding gastritis as a technical factor affecting the surgical technique. Antritis and gastritis usually cause stomach wall thickness which can interrupt stapler function or even can cause serosal tear during the dissection. We report a video presentation of laparoscopic sleeve gastrectomy in a morbidly obese patient with antritis. Choosing black cartridge for patients with Helicobacter pylori gastritis might be the optimal technique for division of the antrum in laparoscopic sleeve gastrectomy. Further studies are required to clarify this parameter.

Gastric wall thickness and stapling in laparoscopic sleeve gastrectomy - a literature review

Despite the growing experience of bariatric surgeons in performing laparoscopic sleeve gastrectomy, the number of complications involving staple line leaks remains constant. Hence a solution to avoid such complications is still sought. A defect of the staple line may be the consequence of an inappropriate choice of staple size in relation to gastric wall thickness. Due to the variable nature of gastric wall thickness, the choice of proper staple height is not obvious. In the few studies in which gastric wall thickness was measured, it was observed to decrease gradually from the antrum to the fundus. However, the authors are divided on the issue of whether gender and body mass index influence gastric wall thickness. The question whether there are other perioperative factors that would allow gastric wall thickness to be predicted remains unanswered.