Colonic transit in patients after anterior resection: prospective, comparative study using single-photon emission CT/CT scintigraphy
Abstract Background Bowel dysfunction after anterior resection is well documented, but its pathophysiology remains poorly understood. No study has assessed whether postoperative variation in colonic transit contributes to symptoms. This study measured colonic transit using planar scintigraphy and si...
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| Veröffentlicht in: | British journal of surgery 2020-04, Vol.107 (5), p.567-579 |
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| description | Abstract
Background
Bowel dysfunction after anterior resection is well documented, but its pathophysiology remains poorly understood. No study has assessed whether postoperative variation in colonic transit contributes to symptoms. This study measured colonic transit using planar scintigraphy and single-photon emission CT (SPECT)/CT in patients after anterior resection, stratified according to postoperative bowel function.
Methods
Symptoms were assessed using the low anterior resection syndrome (LARS) score. Following gallium-67 ingestion, scintigraphy was performed at predefined time points. Nine regions of interest were defined, and geometric centre (GC), percentage isotope retained, GC velocity index and colonic half-clearance time (T½) determined. Transit parameters were compared between subgroups based on LARS score using receiver operating characteristic (ROC) curve analyses.
Results
Fifty patients (37 men; median age 72·6 (range 44·4–87·7) years) underwent planar and SPECT scintigraphy. Overall, 17 patients had major and nine had minor LARS; 24 did not have LARS. There were significant differences in transit profiles between patients with major LARs and those without LARS: GCs were greater (median 5·94 (range 2·35–7·72) versus 4·30 (2·12–6·47) at 32 h; P = 0·015); the percentage retained isotope was lower (median 53·8 (range 6·5–100) versus 89·9 (38·4–100) per cent at 32 h; P = 0·002); GC velocity indices were greater (median 1·70 (range 1·18–1·92) versus 1·45 (0·98–1·80); P = 0·013); and T½ was shorter (median 38·3 (17·0–65·0) versus 57·0 (32·1–160·0) h; P = 0·003). Percentage tracer retained at 32 h best discriminated major LARS from no LARS (area under curve (AUC) 0·828).
Conclusion
Patients with major LARS had accelerated colonic transit compared with those without LARS, which may help explain postoperative bowel dysfunction in this group. The percentage tracer retained at 32 h had the greatest AUC value in discriminating such patients.
Graphical Abstract
This study investigated changes in colonic transit after anterior resection, and demonstrated differences in transit profiles between patients with major low anterior resection syndrome (LARS) and those without LARS. This suggests that LARS may be, at least in part, due to changes in postoperative colonic motility, rather than just neorectal or postoperative pelvic floor dysfunction.
Graphical Abstract
Increased colonic transit in LARS |
| doi_str_mv | 10.1002/bjs.11471 |
| format | Article |
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Background
Bowel dysfunction after anterior resection is well documented, but its pathophysiology remains poorly understood. No study has assessed whether postoperative variation in colonic transit contributes to symptoms. This study measured colonic transit using planar scintigraphy and single-photon emission CT (SPECT)/CT in patients after anterior resection, stratified according to postoperative bowel function.
Methods
Symptoms were assessed using the low anterior resection syndrome (LARS) score. Following gallium-67 ingestion, scintigraphy was performed at predefined time points. Nine regions of interest were defined, and geometric centre (GC), percentage isotope retained, GC velocity index and colonic half-clearance time (T½) determined. Transit parameters were compared between subgroups based on LARS score using receiver operating characteristic (ROC) curve analyses.
Results
Fifty patients (37 men; median age 72·6 (range 44·4–87·7) years) underwent planar and SPECT scintigraphy. Overall, 17 patients had major and nine had minor LARS; 24 did not have LARS. There were significant differences in transit profiles between patients with major LARs and those without LARS: GCs were greater (median 5·94 (range 2·35–7·72) versus 4·30 (2·12–6·47) at 32 h; P = 0·015); the percentage retained isotope was lower (median 53·8 (range 6·5–100) versus 89·9 (38·4–100) per cent at 32 h; P = 0·002); GC velocity indices were greater (median 1·70 (range 1·18–1·92) versus 1·45 (0·98–1·80); P = 0·013); and T½ was shorter (median 38·3 (17·0–65·0) versus 57·0 (32·1–160·0) h; P = 0·003). Percentage tracer retained at 32 h best discriminated major LARS from no LARS (area under curve (AUC) 0·828).
Conclusion
Patients with major LARS had accelerated colonic transit compared with those without LARS, which may help explain postoperative bowel dysfunction in this group. The percentage tracer retained at 32 h had the greatest AUC value in discriminating such patients.
Graphical Abstract
This study investigated changes in colonic transit after anterior resection, and demonstrated differences in transit profiles between patients with major low anterior resection syndrome (LARS) and those without LARS. This suggests that LARS may be, at least in part, due to changes in postoperative colonic motility, rather than just neorectal or postoperative pelvic floor dysfunction.
Graphical Abstract
Increased colonic transit in LARS</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.11471</identifier><identifier>PMID: 32154585</identifier><language>eng</language><publisher>Chichester, UK: Oxford University Press</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Colon ; Colon - diagnostic imaging ; Colon - physiopathology ; Female ; Gastrointestinal Transit ; Humans ; Life Sciences & Biomedicine ; Male ; Middle Aged ; Postoperative Period ; Prospective Studies ; Rectal Neoplasms - diagnostic imaging ; Rectal Neoplasms - physiopathology ; Rectal Neoplasms - surgery ; Rectum - diagnostic imaging ; Rectum - physiopathology ; Rectum - surgery ; ROC Curve ; Science & Technology ; Surgery ; Tomography, Emission-Computed, Single-Photon</subject><ispartof>British journal of surgery, 2020-04, Vol.107 (5), p.567-579</ispartof><rights>2020 BJS Society Ltd Published by John Wiley & Sons Ltd 2020</rights><rights>2020 BJS Society Ltd Published by John Wiley & Sons Ltd</rights><rights>2020 BJS Society Ltd Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2020 BJS Society Ltd. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>15</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000521124800013</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c3831-29fb1cbc92bd1f75fa6e19d44656d8f9c1fae8d565b9e6d42b5deca5fe7ec1ec3</citedby><cites>FETCH-LOGICAL-c3831-29fb1cbc92bd1f75fa6e19d44656d8f9c1fae8d565b9e6d42b5deca5fe7ec1ec3</cites><orcidid>0000-0002-7614-855X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fbjs.11471$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fbjs.11471$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27922,27923,45572,45573</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32154585$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ng, K-S</creatorcontrib><creatorcontrib>Russo, R</creatorcontrib><creatorcontrib>Gladman, M A</creatorcontrib><title>Colonic transit in patients after anterior resection: prospective, comparative study using single-photon emission CT/CT scintigraphy</title><title>British journal of surgery</title><addtitle>BRIT J SURG</addtitle><addtitle>Br J Surg</addtitle><description>Abstract
Background
Bowel dysfunction after anterior resection is well documented, but its pathophysiology remains poorly understood. No study has assessed whether postoperative variation in colonic transit contributes to symptoms. This study measured colonic transit using planar scintigraphy and single-photon emission CT (SPECT)/CT in patients after anterior resection, stratified according to postoperative bowel function.
Methods
Symptoms were assessed using the low anterior resection syndrome (LARS) score. Following gallium-67 ingestion, scintigraphy was performed at predefined time points. Nine regions of interest were defined, and geometric centre (GC), percentage isotope retained, GC velocity index and colonic half-clearance time (T½) determined. Transit parameters were compared between subgroups based on LARS score using receiver operating characteristic (ROC) curve analyses.
Results
Fifty patients (37 men; median age 72·6 (range 44·4–87·7) years) underwent planar and SPECT scintigraphy. Overall, 17 patients had major and nine had minor LARS; 24 did not have LARS. There were significant differences in transit profiles between patients with major LARs and those without LARS: GCs were greater (median 5·94 (range 2·35–7·72) versus 4·30 (2·12–6·47) at 32 h; P = 0·015); the percentage retained isotope was lower (median 53·8 (range 6·5–100) versus 89·9 (38·4–100) per cent at 32 h; P = 0·002); GC velocity indices were greater (median 1·70 (range 1·18–1·92) versus 1·45 (0·98–1·80); P = 0·013); and T½ was shorter (median 38·3 (17·0–65·0) versus 57·0 (32·1–160·0) h; P = 0·003). Percentage tracer retained at 32 h best discriminated major LARS from no LARS (area under curve (AUC) 0·828).
Conclusion
Patients with major LARS had accelerated colonic transit compared with those without LARS, which may help explain postoperative bowel dysfunction in this group. The percentage tracer retained at 32 h had the greatest AUC value in discriminating such patients.
Graphical Abstract
This study investigated changes in colonic transit after anterior resection, and demonstrated differences in transit profiles between patients with major low anterior resection syndrome (LARS) and those without LARS. This suggests that LARS may be, at least in part, due to changes in postoperative colonic motility, rather than just neorectal or postoperative pelvic floor dysfunction.
Graphical Abstract
Increased colonic transit in LARS</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Colon</subject><subject>Colon - diagnostic imaging</subject><subject>Colon - physiopathology</subject><subject>Female</subject><subject>Gastrointestinal Transit</subject><subject>Humans</subject><subject>Life Sciences & Biomedicine</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Postoperative Period</subject><subject>Prospective Studies</subject><subject>Rectal Neoplasms - diagnostic imaging</subject><subject>Rectal Neoplasms - physiopathology</subject><subject>Rectal Neoplasms - surgery</subject><subject>Rectum - diagnostic imaging</subject><subject>Rectum - physiopathology</subject><subject>Rectum - surgery</subject><subject>ROC Curve</subject><subject>Science & Technology</subject><subject>Surgery</subject><subject>Tomography, Emission-Computed, Single-Photon</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>EIF</sourceid><recordid>eNqNkk9v1DAQxS0EokvhwBdAluCARNP12HH-cCsRFFAlDiznyHEmrVdZO7Wdor3zwXG6Sw9ISFzGHun3rOeZR8hLYOfAGF9323AOkJfwiKxAFDLjUFSPyYoxVmYguDghz0LYMgaCSf6UnAgOMpeVXJFfjRudNZpGr2wwkRpLJxUN2hioGiJ6qmyqxnnqMaCOxtn3dPIuTEtzh2dUu92kvFoaGuLc7-kcjL2mSxkxm25cdJbizoSQxLTZrJsNDdrYaK69mm72z8mTQY0BXxzPU_Lj08dN8zm7-nb5pbm4yrSoBGS8HjrQna5518NQykEVCHWf54Us-mqoNQwKq14Wsqux6HPeyR61kgOWqAG1OCVvD-8m-7czhtgmTxrHUVl0c2i5KGVVipKJhL7-C9262dvkbqEqqCUUZaJeHam522HfTt7slN-3f-abgOoA_MTODenPaDU-YGk_kgPwvGLLbhoT1TLexs02Jum7_5cmen2kzYj7BwxYuySkTQlp7xPSfvj6_f6SFG8OCjdP_-bFb_4zuhc</recordid><startdate>202004</startdate><enddate>202004</enddate><creator>Ng, K-S</creator><creator>Russo, R</creator><creator>Gladman, M A</creator><general>Oxford University Press</general><general>John Wiley & Sons, Ltd</general><general>Oxford Univ Press</general><scope>95M</scope><scope>ABMOY</scope><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7614-855X</orcidid></search><sort><creationdate>202004</creationdate><title>Colonic transit in patients after anterior resection: prospective, comparative study using single-photon emission CT/CT scintigraphy</title><author>Ng, K-S ; Russo, R ; Gladman, M A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3831-29fb1cbc92bd1f75fa6e19d44656d8f9c1fae8d565b9e6d42b5deca5fe7ec1ec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Colon</topic><topic>Colon - diagnostic imaging</topic><topic>Colon - physiopathology</topic><topic>Female</topic><topic>Gastrointestinal Transit</topic><topic>Humans</topic><topic>Life Sciences & Biomedicine</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Postoperative Period</topic><topic>Prospective Studies</topic><topic>Rectal Neoplasms - diagnostic imaging</topic><topic>Rectal Neoplasms - physiopathology</topic><topic>Rectal Neoplasms - surgery</topic><topic>Rectum - diagnostic imaging</topic><topic>Rectum - physiopathology</topic><topic>Rectum - surgery</topic><topic>ROC Curve</topic><topic>Science & Technology</topic><topic>Surgery</topic><topic>Tomography, Emission-Computed, Single-Photon</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ng, K-S</creatorcontrib><creatorcontrib>Russo, R</creatorcontrib><creatorcontrib>Gladman, M A</creatorcontrib><collection>Conference Proceedings Citation Index - Science (CPCI-S)</collection><collection>Conference Proceedings Citation Index - Science (CPCI-S) 2020</collection><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ng, K-S</au><au>Russo, R</au><au>Gladman, M A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Colonic transit in patients after anterior resection: prospective, comparative study using single-photon emission CT/CT scintigraphy</atitle><jtitle>British journal of surgery</jtitle><stitle>BRIT J SURG</stitle><addtitle>Br J Surg</addtitle><date>2020-04</date><risdate>2020</risdate><volume>107</volume><issue>5</issue><spage>567</spage><epage>579</epage><pages>567-579</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><abstract>Abstract
Background
Bowel dysfunction after anterior resection is well documented, but its pathophysiology remains poorly understood. No study has assessed whether postoperative variation in colonic transit contributes to symptoms. This study measured colonic transit using planar scintigraphy and single-photon emission CT (SPECT)/CT in patients after anterior resection, stratified according to postoperative bowel function.
Methods
Symptoms were assessed using the low anterior resection syndrome (LARS) score. Following gallium-67 ingestion, scintigraphy was performed at predefined time points. Nine regions of interest were defined, and geometric centre (GC), percentage isotope retained, GC velocity index and colonic half-clearance time (T½) determined. Transit parameters were compared between subgroups based on LARS score using receiver operating characteristic (ROC) curve analyses.
Results
Fifty patients (37 men; median age 72·6 (range 44·4–87·7) years) underwent planar and SPECT scintigraphy. Overall, 17 patients had major and nine had minor LARS; 24 did not have LARS. There were significant differences in transit profiles between patients with major LARs and those without LARS: GCs were greater (median 5·94 (range 2·35–7·72) versus 4·30 (2·12–6·47) at 32 h; P = 0·015); the percentage retained isotope was lower (median 53·8 (range 6·5–100) versus 89·9 (38·4–100) per cent at 32 h; P = 0·002); GC velocity indices were greater (median 1·70 (range 1·18–1·92) versus 1·45 (0·98–1·80); P = 0·013); and T½ was shorter (median 38·3 (17·0–65·0) versus 57·0 (32·1–160·0) h; P = 0·003). Percentage tracer retained at 32 h best discriminated major LARS from no LARS (area under curve (AUC) 0·828).
Conclusion
Patients with major LARS had accelerated colonic transit compared with those without LARS, which may help explain postoperative bowel dysfunction in this group. The percentage tracer retained at 32 h had the greatest AUC value in discriminating such patients.
Graphical Abstract
This study investigated changes in colonic transit after anterior resection, and demonstrated differences in transit profiles between patients with major low anterior resection syndrome (LARS) and those without LARS. This suggests that LARS may be, at least in part, due to changes in postoperative colonic motility, rather than just neorectal or postoperative pelvic floor dysfunction.
Graphical Abstract
Increased colonic transit in LARS</abstract><cop>Chichester, UK</cop><pub>Oxford University Press</pub><pmid>32154585</pmid><doi>10.1002/bjs.11471</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-7614-855X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Online Library - AutoHoldings Journals; MEDLINE; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Adult Aged Aged, 80 and over Colon Colon - diagnostic imaging Colon - physiopathology Female Gastrointestinal Transit Humans Life Sciences & Biomedicine Male Middle Aged Postoperative Period Prospective Studies Rectal Neoplasms - diagnostic imaging Rectal Neoplasms - physiopathology Rectal Neoplasms - surgery Rectum - diagnostic imaging Rectum - physiopathology Rectum - surgery ROC Curve Science & Technology Surgery Tomography, Emission-Computed, Single-Photon |
| title | Colonic transit in patients after anterior resection: prospective, comparative study using single-photon emission CT/CT scintigraphy |
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