Imaging of patients treated with bariatric surgery

Abstract

SummaryOver the past few years, obesity has become a major clinical and population concern in the majority of developed countries. Obesity leads to significant systemic disorders, such as hypertension, hypercholesterolemia, hypertriglyceridemia and insulin resistance, and also increases the risk of developing cardiovascular diseases (ischemic heart disease, ischemic stroke), metabolic diseases (type 2 diabetes), certain types of cancer, and degenerative bone disorders (osteoarthritis). Health hazards associated with epidemic of obesity and potential benefits of weight loss have spurred interest in new treatment methods. Bariatric surgical procedures constitute a recognized alternative in cases where conservative management of obesity fails. Several bariatric operations can be distinguished: restrictive procedures, such as adjustable gastric band (AGB) and vertical banded gastroplasty (VBG); predominantly malabsorptive procedures, such as biliopancreatic diversion (BPD), and a combination of both methods, such as Roux-en-Y gastric bypass. The adverse consequences of surgical treatment of obesity include i.a.: intestinal anastomotic leakage, impaired intestinal permeability and internal hernia, dilatation of the stomach, gastrointestinal anastomotic stenosis, marginal ulceration, incisional hernia. Basic knowledge of procedures in the surgical treatment of obesity is of vital importance for the radiologist during evaluation of upper gastrointestinal tract in the early and late postoperative period, allowing correct interpretation of acquired images as well as recognition of typical complications.

High-fat Diet Accelerates Intestinal Tumorigenesis Through Disrupting Intestinal Cell Membrane Integrity

“…In obese patients and animal models of obesity, intestinal permeability is shown to be increased possibly due to impairment of TJs. 14 – 16 Although the causes and mechanisms of disruptions in TJs are not fully understood, alterations in microbiota composition and chronic low-grade inflammation may have been suggested to be linked to intestinal membrane integrity. 17 – 19 The increase of intestinal permeability causes the development of metabolic endotoxemia with increased lipopolysaccharide (LPS) translocation into the systemic circulation.…”

Obese patients and radiography literature: what do we know about a big issue?

“…Obesity is an important issue in health care due to extensive associated secondary conditions, especially venous insufficiency and degenerative joint disease, which are often the clinical context for plain radiography referrals 2–5. The strain of carrying additional weight is especially prevalent on the knee and hip joints.…”

“…Obesity is a complex issue in health care because of extensive indirect effects and associated medical conditions such as type 2 diabetes, coronary artery disease, hypertension, asthma, stroke, gout, venous insufficiency, degenerative joint disease and sleep apnoea 2–5. In addition, obesity has a large economic impact with reported direct costs in Australia estimated at $830 million 6,7…”

Contemporary follow-up imaging after endovascular repair of lower extremity atherosclerotic lesions

“…However, this technique presents limited application in stenoses below 50% and in long stents. In extremely obese patients, when ultrasound beam penetration is limited, especially when using linear probes, the diagnostic performance of US may also be inadequate [25]. In such cases, there are several solutions, including harmonic and crossed-beam imaging, that are available in modern US units as well as vendor-specific noise reduction techniques.…”