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Stier et al. Mini-invasive Surg 2020;4:18 I http://dx.doi.org/10.20517/2574-1225.2019.75 Page 3 of 11

of an aromatised, acidulous sherbet or just as sour candy. A contrast itself is not necessary for the
examination. Patients were already sitting on the CT-table during the intake. The effervescent powder
creates an instant froth, thus causing immediate distention of the stomach and its adjacent anatomical
structures during examination. In addition, the patients were instructed to keep the froth strictly within
the stomach and therefore avoid belching. Another reason for insufficient distention can be a prolonged
time span between intake and examination. Thus, immediately after intake, the patient lies back to a supine
examination position. Directly afterwards, the images are acquired using a Philips Brilliance 64-slice CT-
scanner. The scan itself is recorded with a collimation of 32 mm × 1.25 mm. This defines the table traverse
speed during one gantry rotation of 32 mm, thus capturing a 1.25 mm layer. The corresponding pitch factor
®
is 0.906. After the examination, the 3D- reconstruction is calculated with the Philips workstation and the
IntelliSpace Portal. The resulting 3D-pictures are 360° rotatable, and accurately display the stomach and its
adjacent gastrointestinal structures, here integrated in the patient’s semi lucent skeleton.

Statistics
During 24 months, 279 patients underwent the 3D-CT at Sana Klinikum Offenbach, a high-volume
certified centre of excellence for obesity and metabolic surgery by the European Accreditation Council
for Bariatric Surgery, as part of our standard diagnostic algorithm for patients after bariatric surgery with
remaining unclear symptoms after standard diagnostic examinations (UE and UGI). Patients with various
bariatric procedures were included [sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), one-
anastomosis/mini gastric bypass (OAGB/MGB), gastric banding (GB), vertical banded gastrostomy (VBG)
and biliopancreatic diversion (BPD)], which led to the definition of three main subgroups (Bypass, SG and
others). Examination data were collected prospectively and evaluated retrospectively.

Demographic and clinical data include gender, age, height in cm, weight in kg, BMI in kg/m² prior to
surgery and prior to the examination and excess weight loss (EWL) in assuming ideal body weight to be
2
that equivalent to a BMI of 25 kg/m . Time between surgery and examination was considered. Statistical
analysis was performed using SPSS 11.0 statistical software for Microsoft Windows (SPSS Inc., Chicago,
IL, USA). Continuous variables, when normally distributed, were reported as mean, standard deviation
(SD) and range. Intergroup differences were tested by a two-sample t test for normally distributed data. A
P-value < 0.05 was considered significant.

The study was conducted in accordance with the principles of the Declaration of Helsinki. This analysis
represents a partial result of a study, evaluating postsurgical endoscopies within this period, which was
reviewed and approved by the ethics committee of the regional regulatory institution, Landesärztekammer
Hessen (FF 111/2016; ClinicalTrials.gov Identifier: NCT03532646). Additionally, all participants provided
written informed consent for data sharing.

RESULTS

Descriptive statistics
General patient data
This study included 279 post-bariatric patients [Table 1], of whom 223 were females (79.9%). Only some of
the patients came from the centre’s primary collection. Nearly 37% (103/279, 36.91%) were referred from
other national or international bariatric centres, with the treatment mandate to solve complications that
were previously intractable.

Significantly more than half of the patients (183/279; 65.6%) underwent a bypass procedure (proximal
Roux-en-Y, n = 168, and OAGB/MGB, n = 15) and 74 patients (26.5%) had a sleeve gastrectomy. Patients’
data are shown in Table 1.