50
uptake, as demonstrated by a vagotomized animal study.
25
Scintigraphy with 99mTcO-
4
in
SPECT has been employed to evaluate gastric volume in models of digestive physiology
assessing postprandial gastric accommodation,
26
and also to evaluate gastric tube emptying
after esophagectomies.
27
It was our choice to estimate the perfusion of gastroplasties due to
its non-invasive character, with negligible radioactive dosage, the ability to be reproduced
in other centers, low cost, to be timely applied regarding the event anastomotic fistula, and
relatively available within our health system. We believe that the above-mentioned features
add advantages regarding other previously-described methods.
The application of the comparison of upper (A) and lower (C) segments of the same
patient, whose distal segment is the standard of comparison for a good perfusion, was the
solution found after the analysis of previous studies on gastric perfusion. There were
evidences showing homogenous distribution of radiotracers within the gastric tube in
animal models, and also regarding the usual technique that maintains the right gastric artery
and the right gastroepiploic artery at their antropyloric location, which is known to provide
nourishment to all the residual stomach, according to arteriographic studies.
28
Thus, the
studied area (segment A), where organ section, vascular ligation and anastomosis with
esophageal remnant takes place, is compared to another, less manipulated area (segment C),
and also near the origin of remaining vascular supply of the same viscus. Both anatomically
and technically, due to vascular branch preservation, these two areas, A and C, are the
extreme opposites from the same organ, and exactly for that reason they were chosen to
compare the radiotracer uptake.
The experience with the SPECT method and 99mTcO-
4
showed that those patients
who developed anastomotic fistulas presented significantly reduced perfusion of the upper
segment (A), when compared to those patients without fistulas, despite the small number of