NORMAL RANGE OF ENDOSCOPIC MUCOSAL OXYGEN SATURATION MEASUREMENTS IN POST-BARIATRIC SURGERY PATIENTS
Daniel Szvarca, Trent Walradt*, Cem Simsek, Pichamol Jirapinyo, Christopher C. Thompson
Gastroenterology, Brigham and Women's Hospital, Boston, MA
Introduction
Measurements of gastrointestinal mucosal oxygen saturation (StO2) is now possible by means of a nascent endoscopic technology that uses multi-wavelength emission and spectral analysis of reflected light. Alteration in blood flow is one of the proposed pathologic processes leading to complications after bariatric surgery. Therefore, measuring StO2 in post-bariatric surgery patients may augment the diagnostic and therapeutic yield of white light endoscopy. We collected data from healthy post-bariatric surgery patients to define the normal range in this population.
Methods
All patients with a history of Roux-en-Y gastric bypass (RYGB) who underwent upper endoscopic examination with StO2 imaging from September 2021 to October 2022 in a bariatric endoscopy clinic were included. Patients with gastrointestinal pathology, or any other gastrointestinal surgeries were excluded. We collected pseudo-colored oxygen saturation scale images from several anatomic locations and used dedicated software to quantify StO2. We also collected clinical and demographic data.
Results
A total of 31 patients were included. The study population consisted of 29 females (94%) and 2 males (6%) with a mean age of 51 (± 12). The esophagus had the lowest saturation at 16% (± 19%) (p <0 .00001). StO2 level of the gastric pouch was 50% (±17%), and the gastric side of the gastro-jejunal anastomotic was 44% (± 16%). StO2 level of the Roux limb was 46% (± 18%). The gastric remnant was also measured in two cases by passing the endoscope through a gastro-gastric fistula and a higher StO2 level was observed when compared to the pouch (31% vs. 85% and 56% vs. 81%).
Conclusion
This is the largest study to evaluate StO2 level of the GI mucosa in post-bariatric surgery patients. In RYGB patients, the esophagus had a lower oxygen saturation than the distal GI tract. In addition, StO2 levels in the gastric remnant were higher than the gastric pouch. These findings may serve as the groundwork for future studies using StO2 in post-bariatric surgery patients.
Oxygen saturation scales of gastrointestinal mucosa demonstrated by pseudo colored imaging from post-bariatric surgery patients. A: esophagus, B: gastric pouch, C: gastro-jejunal anastomosis, D: jejunum.
Table showing population characteristics and mucosal oxygen saturation values
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