Improved scintigraphic assessment of occult leakages in adjustable gastricbands using Tc-99m-labelled human albumin colloid

Background: Adjustable gastric banding has become the preferred procedure i n Europe for the treatment of morbid obesity. A complication of this treatm ent is the presence of leakage in the system. The knowledge of the localiza tion of the leak is essential for planning the reoperation procedure. Patients and Methods: In a series of 325 adjustable gastric bandings, we ob served 10 band leakages. In 3 cases, fluoroscopy failed to detect fluid ext ravasation. We present a sensitive and simple scintigraphic method for the detection of gastric band leakage in these patients using 37 MBq of a Tc-99 m-human albumin colloid suspension. Imaging was started immediately after t he dose application. During the first minute, images were acquired dynamica lly with 1 frame every 2 seconds. Afterwards, a static image was obtained e very 10 minutes, up to 60 minutes post-injection. Then the system was empti ed completely to detect tracer extravasation and consecutive reabsorption d uring 60 minutes. The study was analyzed by using the regions of interest ( ROI) technique drawn on the following points: injection reservoir, tube, an terior band, posterior band, and an adjacent region which was taken as back ground. Results: During the first hour, ROI analysis showed a clear diminution in t he number of counts contained in the defect parts of the band, whereas it r emained constant in the other locations. After system emptying, detection o f tracer extravasation further strengthened the diagnosis of band leakage i n all patients. Conclusion: This new approach using the Tc-99m-human albumin colloid suspen sion with ROI analysis is an effective and simple method to detect occult l eakages in adjustable gastric bands which escaped detection by fluoroscopy, In contrast to previously described scintigraphic methods, this investigat ion is able to demonstrate the exact site of leakage.