Abstract
1096
Objectives: The method of gastrectomy is known to influence glucose homeostasis. 18F-fluorodeoxyglucose (FDG) Positron Emission Tomography/Computed Tomography (PET/CT) acquired after gastrectomy often reveals newly developed physiologic small bowel uptake. We evaluated the correlation between newly developed small bowel FDG uptake and glucose homeostasis in post-gastrectomy gastric cancer patients.
Methods: We retrospectively analyzed 239 non-diabetic patients who underwent staging and follow-up FDG PET/CT before and after gastrectomy for gastric cancer at a tertiary hospital. Post-operative small bowel glycolysis was quantified by recording intestinal total lesion glycolysis (TLG). Receiver operating characteristic analysis was used to determine the TLG cut-off value that predicted fasting serum glucose decrement ≥10 mg/dL with the highest sensitivity. TLG was assessed with regard to surgical method (Billroth type I, II [B1, B2], Roux-en-Y gastroduodenostomy [RYGB]), fasting glucose decrement, and other clinically important factors.
Results: Patients’ weight, fasting glucose, cholesterol, TLG, and body fat significantly decreased after surgery. Glucose decrement was significantly associated with fasting glucose, surgical methods, total cholesterol, TLG, and total body fat on univariate analysis. Multivariate analysis showed that B2 surgery (odds ratio: 6.51, 95% confidence interval: 2.47-17.18) and TLG (odds ratio: 3.17, 95% confidence interval: 1.49-6.73) were significantly correlated with glucose decrement. High small bowel glycolysis (TLG≥42.0) correlated with glucose decrement, with highest sensitivity (94.1%) in obese patients (body mass index≥23 kg/m2) who underwent RYGB.
Conclusions: Newly developed small bowel glycolysis on post-gastrectomy FDG PET/CT is correlated with glucose decrement. These findings suggest a potential role of FDG PET/CT in the evaluation of small bowel glycolysis and glucose control1.