Intraoperative Measuring of Small Bowel Length Compared to Measuring by Magnetic Resonance Imaging (MRI) in Morbid Obese Patients

NCT ID: NCT00740662

Last Updated: 2012-12-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Total Enrollment

7 participants

Study Classification

OBSERVATIONAL

Study Start Date

2008-01-31

Study Completion Date

2010-07-31

Brief Summary

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An important step during a gastric bypass operation for the treatment of morbid obesity is the measuring of the small bowel length. At several reoperations we found a length increase of the lowest part of the small intestine of up to 80% compared to the measured length at the initial operation. On the one hand, this reflects a normal technical error of small bowel measuring due to the variable state of contraction of the bowel, but on the other hand, it could also be due to a compensatory increase in intestinal length after the operation. New protocols allow measuring of the small bowel length by MRI. Comparing the preoperative and later on several postoperative measurements by MRI with the initial intraoperative length measuring should allow to validate the new MRI protocol and in the same time quantify the eventual small bowel length increase. We plan to include 20 patients in this study.

Detailed Description

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Background:

An important step during a gastric bypass operation for the treatment of morbid obesity is the measuring of the small bowel length in order to define the lengths of the alimentary, biliopancreatic and common channel. The measuring itself is technically simple but has always an error due to the variable state of contraction of the small bowel. In distal gastric bypass a common channel length of 100 to 150 cm is chosen which induces an iatrogenic short bowel syndrome. At several reoperations we found a length increase of the common channel of up to 80% compared to the measured length at the initial operation. Former studies seem to indicate that an adaptation of small bowel length may occur in animals with short bowel syndrome or after intestinal bypass surgery. Longterm results of gastric bypass surgery often show weight regain after 3 to 5 years which could be due to the afore mentioned compensatory mechanism.

Newer MRI protocols allow for non-invasive measurement of the small bowel length. Comparing the preoperative and later on several postoperative measurements by MRI with the initial intraoperative length measuring should allow to validate the new MRI protocol and in the same time quantify the eventual small bowel length increase.

Objective:

In-vivo verification of small bowel length measurements made by MRI, quantification of a possible increase of the common channel length in the long run after distal gastric bypass.

Methods:

The preoperative small bowel length measurement by MRI is compared to the length measured intraoperatively. MRIs before discharge postoperatively as well as after 6 and 12 months are used to detect an eventual increase of the common channel length.

Conditions

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Morbid Obesity Weight Loss

Keywords

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morbid obesity small bowel gastric bypass weight loss

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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1

Distal gastric bypass

Distal gastric bypass

Intervention Type PROCEDURE

Distal gastric bypass

Interventions

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Distal gastric bypass

Distal gastric bypass

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* morbid obese patient
* scheduled for distal gastric bypass
* informed consent for operation and study obtained

Exclusion Criteria

* history of former small bowel resection
* weight \> 150 kg
* history of claustrophobia
* general contraindications for MRI (pacer, joint prosthesis, ear implant, etc.)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Insel Gruppe AG, University Hospital Bern

OTHER

Sponsor Role lead

Responsible Party

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Department of Visceral and Transplantsurgery, Bern University Hospital

Principal Investigators

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Jean-Marc Heinicke, MD

Role: STUDY_DIRECTOR

Department of Visceral and Transplant Surgery, Bern University Hospital

Philipp C Nett, Dr

Role: PRINCIPAL_INVESTIGATOR

DRNN, Inselspital, Bern University Hospital, Switzerland

Locations

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Department of Visceral and Transplantsurgery, Bern University Hopsital

Bern, , Switzerland

Site Status

Institute of diagnostic, interventional and pediatric Radiology, Bern University Hospital

Bern, , Switzerland

Site Status

Countries

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Switzerland

References

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Miskowiak J, Andersen B. Intestinal adaptation after jejunoileal bypass for morbid obesity: a possible explanation for inadequate weight loss. Br J Surg. 1983 Jan;70(1):27-8. doi: 10.1002/bjs.1800700110.

Reference Type BACKGROUND
PMID: 6824877 (View on PubMed)

Swaniker F, Guo W, Fonkalsrud EW, Brown T, Newman L, Ament M. Adaptation of rabbit small intestinal brush-border membrane enzymes after extensive bowel resection. J Pediatr Surg. 1995 Jul;30(7):1000-2; discussion 1003. doi: 10.1016/0022-3468(95)90329-1.

Reference Type BACKGROUND
PMID: 7472920 (View on PubMed)

Hughes CA, Ducker DA. Adaptation of the small intestine--does it occur in man? Scand J Gastroenterol Suppl. 1982;74:149-58.

Reference Type BACKGROUND
PMID: 6815778 (View on PubMed)

Wyss M, Froehlich JM, Patak MA, Juli CF, Scheidegger MB, Zollikofer CL, Wentz KU. Gradient-enhanced volume rendering: an image processing strategy to facilitate whole small bowel imaging with MRI. Eur Radiol. 2007 Apr;17(4):1081-8. doi: 10.1007/s00330-006-0472-2. Epub 2006 Oct 5.

Reference Type BACKGROUND
PMID: 17021699 (View on PubMed)

Patak MA, Froehlich JM, von Weymarn C, Breitenstein S, Zollikofer CL, Wentz KU. Non-invasive measurement of small-bowel motility by MRI after abdominal surgery. Gut. 2007 Jul;56(7):1023-5. doi: 10.1136/gut.2007.120816. No abstract available.

Reference Type BACKGROUND
PMID: 17566036 (View on PubMed)

Other Identifiers

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KEK248_07

Identifier Type: -

Identifier Source: org_study_id