Patency of anastomoses after bilio-intestinal bypass: Radioisotope demonstration

Background: Bilio-intestinal bypass (BIB) is effective for the treatment of refractory obesity. BIB permits bile flow into the non-functional jejunum, whereas food transit occurs via the remaining intestine. We used the radio isotope method of Tc-99m-Hida cholescintigraphy (HC) in the follow-up of pa tients. Methods: 21 patients were studied 3 months to 3 years after BIB with HC. Af ter 3 hours acquisition, images were reviewed by two independent observers. Regions of interest (ROIs) were drawn on images: liver parenchyma, cholecy sto-jejunal anastomosis (CC), choledochus (COL). Radioactivity taken up by liver was compared with radioactivity of CC and COL. % radioactivity passin g through CC (%CC) and through COL (%COL) were determined. The final parame ter, -COL, indicates the radioactive bile which does not pass through the c holedochus. Results: Anastomoses; were found patent a few months to 3 years after opera tion. -COL showed linear correlation with the decrease in cholesterolemia a nd in body weight in the I st year after BIB. Conclusions: HC shows passage of radioactive bile through anastomoses and p rovides semiquantitative evaluation of bile flux diversion. Bile flux towar ds the gallbladder and non-functional jejunal limb far exceeds flux directe d towards the duodenum via the choledochus.