Prediction of Gastric Dilatation after Gastrectomy Using an Index from Abdominal X-Ray Radiography

Abstract

Purpose: Gastric dilatation due to food retention after gastrectomy is a risk factor for aspiration pneumonia and a prolonged hospital stay, but there is no clear index to define gastric dilatation. In this study, we aimed to identify a clinical index associated with therapeutic intervention for gastric dilatation after gastrectomy, based on abdominal X-ray radiography. Materials and Methods: Of 95 patients who underwent distal gastrectomy at Kitasato University Hospital between January and August 2019, 77 were examined by abdominal X-ray radiography after gastrectomy. The maximum width of the gastric bubble, the distance from the inferior border of the diaphragm to the superior border of the gastric bubble (thickness of the gastric wall), and the vertical diameter of the stomach were measured, and then corrected by the distance from the center of the vertebral body to the left diaphragm angle. Relationships between the measured values and the need for therapeutic intervention were analyzed using ROC curves. Results: Among the 77 cases, 5 required therapeutic intervention. The index most strongly associated with therapeutic intervention was the distance from the center of the vertebral body to the left diaphragm angle relative to the maximum width of the gastric bubble (defined as the gastric dilatation index). The optimal cutoff for this index for predicting therapeutic intervention was 51.0%, with a sensitivity of 100%, specificity of 86%, and AUC of 0.94. Conclusion: The gastric dilatation index in an abdominal X-ray examination may be useful for prediction of the need for therapeutic intervention for gastric dilatation after gastrectomy.