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02-04-2024 | Sleeve Gastrectomy | Original Contributions

Routine Upper Gastrointestinal Series Post-bariatric Surgery: Predictors, Usage, and Utility

Authors: Ketan Dayma, Aruna David, Adil Omer, Haneen Abdel-Dayam, Anan Tawil, Nicholas Socci, Leaque Ahmed, Anthony Gilet, Dana Haddad

Published in: Obesity Surgery | Issue 5/2024

Abstract

Objective

To investigate usage and utility of routine upper gastrointestinal (UGI) series in the immediate post-operative period to evaluate for leak and other complications.

Methods

Single institution IRB-approved retrospective review of patients who underwent bariatric procedure between 01/08 and 12/12 with at least 6-month follow-up.

Results

Out of 135 patients (23%) who underwent routine UGI imaging, 32% of patients were post-gastric bypass (127) versus 4% of sleeve gastrectomy (8). In patients post-gastric bypass, 22 were found with delayed contrast passage, 3 possible obstruction, 4 possible leak, and only 1 definite leak. In patients post-sleeve gastrectomy, 2 had delayed passage of contrast without evidence of a leak. No leak was identified in 443 patients (77%) who did not undergo imaging. The sensitivity and specificity of UGI series for the detection of leak in gastric bypass patients were 100% and 97%, respectively, and the positive and negative predictive values were 20% and 100%, respectively. On univariate and multivariate analysis, sleeve gastrectomy patients (OR 0.4 sleeve vs bypass; P < 0.01) and male patients (OR 0.4 M vs F; P 0.02) were less likely to undergo routine UGI series (OR 0.4 M vs F; P 0.02).

Conclusion

Routine UGI series may be of limited value for the detection of anastomotic leaks after gastric bypass or sleeve gastrectomy and patients should undergo routine imaging based on clinical parameters. Gastric bypass procedure and female gender were factors increasing the likelihood of routine post-operative UGI. Further larger scale analysis of this important topic is warranted.

Graphical Abstract

Greenstein AJ, O’Rourke RW. Abdominal pain after gastric bypass: suspects and solutions. Am J Surg. 2011;201(6):819–27. https://doi.org/10.1016/j.amjsurg.2010.05.007.CrossRefPubMedCentralPubMed

Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294(15):1909–17. https://doi.org/10.1001/jama.294.15.1909.CrossRefPubMed

Quigley S, Colledge J, Mukherjee S, et al. Bariatric surgery: a review of normal postoperative anatomy and complications. Clin Radiol. 2011;66(10):903–14. https://doi.org/10.1016/j.crad.2011.04.017.CrossRefPubMed

Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy and post operative complications. Radiology RSNA. 2014;270(2):327–41.CrossRef

Chandler CR, Srinivas G, Chintapalli KN, et al. Imaging in bariatric surgery: a guide to postsurgical anatomy and common complications. AJR. 2007;2008(190):122–35. https://doi.org/10.2214/AJR.07.2134.CrossRef

Carucci LR. Imaging obese patients: problems and solutions. Abdom Imaging. 2012;38(4):630–46. https://doi.org/10.1007/s00261-012-9959-2.CrossRef

Brockmeyer JR, Simon TE, Jacob RK, et al. Upper gastrointestinal swallow study following bariatric surgery: institutional review and review of the literature. Obes Surg. 2012;22(7):1039–43. https://doi.org/10.1007/s11695-012-0658-4.CrossRefPubMed

Schiesser M, Guber J, Wildi J, et al. Utility of routine versus selective upper gastrointestinal series to detect anastomotic leaks after laparoscopic gastric bypass. Obes Surg. 2010;21:1238–42. https://doi.org/10.1007/s11695-010-0284-y.CrossRef

Csendes A, Braghetto I, León P, et al. Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J Gastrointest Surg. 2010;14:1343–8.CrossRefPubMed

10.

Hamilton EC, Sims TL, Hamilton TT, et al. Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2003;17(5):679–84.CrossRefPubMed

11.

Jurowich C, Thalheimer A, Seyfried F, et al. Gastric leakage after sleeve gastrectomy-clinical presentation and therapeutic options. Langenbecks Arch Surg. 2011;396:981–7.CrossRefPubMed

12.

Toppino M, Cesarani F, Comba A, et al. The role of early radiological studies after gastric bariatric surgery. Obes Surg. 2001;11(4):447–54.CrossRefPubMed

13.

Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7.CrossRefPubMed

14.

Serafini F, Anderson W, Ghassemi P, et al. The utility of contrast studies and drains in the management of patients after Roux-en-Y gastric bypass. Obes Surg. 2002;12(1):34–8.CrossRefPubMed

15.

Kamil N, Chia-En C, Tomasz S, et al. Follow-up after bariatric surgery: are we effective enough? Wideochir Inne Tech Maloinwazyjne. 2021;17(2):299–302.

16.

Haddad D, David A, Abdel-Dayem H, et al. Abdominal imaging post bariatric surgery: predictors, usage and utility. Surg Obes Relat Dis. 2017;13:1327–36.CrossRefPubMed

17.

Doraiswamy A, Rasmussen JJ, Pierce J, et al. The utility of routine postoperative upper GI series following laparoscopic gastric bypass. Surg Endosc. 2007;21:2159–62.CrossRefPubMed

18.

Madan AK, Stoecklein HH, Ternovits CA, et al. Predictive value of upper gastrointestinal studies versus clinical signs for gastrointestinal leaks after laparoscopic gastric bypass. Surg Endosc. 2007;21:194–6.CrossRefPubMed

19.

Daylami R, Rogers AM, King TS, et al. Accuracy of upper gastrointestinal swallow study in identifying strictures after laparoscopic gastric bypass surgery. Surg Obes Relat Dis. 2008;4:96–9.CrossRefPubMed

20.

Triantafyllidis G, Lazoura O, Sioka E, et al. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2011;21:473–8.CrossRefPubMed

21.

Sims TL, Mullican MA, Hamilton EC, et al. Routine upper gastrointestinal Gastrografin swallow after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:66–72.CrossRefPubMed

22.

Palanivelu P, Rachel MG, Saravana K, et al. Management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity: a tertiary care experience and design of a management algorithm. J Minim Access Surg. 2016;12(4):342–9.CrossRefPubMedCentralPubMed

23.

Singh R, Fisher BL. Sensitivity and specificity of postoperative upper GI series following gastric bypass. Obes Surg. 2003;13(1):73–5.CrossRefPubMed

24.

Bertelson NL, Myers JA. Routine postoperative upper gastrointestinal fluoroscopy is unnecessary after laparoscopic adjustable gastric band placement. Surg Endosc. 2010;24:2188–91.CrossRefPubMed

25.

Frezza EE, Mammarappallil JG, Witt C, et al. Value of routine postoperative gastrographin contrast swallow studies after laparoscopic gastric banding. Arch Surg. 2009;144:766–9.CrossRefPubMed

26.

Dallal RM, Bailey L, Nahmias N. Back to basics—clinical diagnosis in bariatric surgery. Routine drains and upper GI series are unnecessary. Surg Endosc. 2007;21:2268–71.CrossRefPubMed

27.

Siep RL, Robey K, Stone A, et al. Comparison of non-routine healthcare utilization in the 2 years following Roux-En-Y gastric bypass and sleeve gastrectomy: a cohort study. Obes Surg. 2019;29(6):1922–31. https://doi.org/10.1007/s11695-019-03793-99.CrossRef

28.

Li K, Gao F, Xue H, et al. Comparative study on laparoscopic sleeve gastrectomy and laparoscopic gastric bypass for treatment of morbid obesity patients. Hepatogastroenterology. 2014;61:319–22.PubMed

29.

Hales CM, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief. 2017;288:1–8. https://www.cdc.gov/nchs/products/databriefs/db288.htm.

30.

Dugan N, Thompson KJ, Barbat S, et al. Male gender is an independent risk factor for patients undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass: an MBSAQIP® database analysis. Surg Endosc. 2020;34:3574–83.CrossRefPubMedCentralPubMed

31.

Kochkodan J, Telem DA, Ghaferi AA. Physiologic and psychological gender differences in bariatric surgery. Surg Endosc. 2018;32(3):1382–8.CrossRefPubMed

Title: Routine Upper Gastrointestinal Series Post-bariatric Surgery: Predictors, Usage, and Utility
Authors: Ketan Dayma
Aruna David
Adil Omer
Haneen Abdel-Dayam
Anan Tawil
Nicholas Socci
Leaque Ahmed
Anthony Gilet
Dana Haddad
Publication date: 02-04-2024
Publisher: Springer US
Keywords: Sleeve Gastrectomy
Bariatric Surgery
Bariatric Surgery
Published in: Obesity Surgery / Issue 5/2024
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-024-07125-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Routine Upper Gastrointestinal Series Post-bariatric Surgery: Predictors, Usage, and Utility

Abstract

Objective

Methods

Results

Conclusion

Graphical Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Graphical Abstract

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