Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 8/2018

01-08-2018 | Original Contributions

Efficacy of Postoperative Upper Gastrointestinal Series (UGI) and Computed Tomography (CT) Scan in Bariatric Surgery: a Meta-analysis on 7516 Patients

Authors: Mario Musella, Valeria Cantoni, Roberta Green, Wanda Acampa, Nunzio Velotti, Paola Maietta, Alberto Cuocolo

Published in: Obesity Surgery | Issue 8/2018

Login to get access

Abstract

Background

To demonstrate the lack of utility and efficacy of routine early postoperative upper gastrointestinal study (UGI) in obese patients undergoing bariatric surgery and to show the higher efficacy of CT scan in cases of clinical suspicion of a leakage, a meta-analysis was performed.

Materials and Methods

A literature search including articles published in last 18 years was performed. For both UGI and CT scan, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. A first analysis considered overall patients, and a second analysis considered only symptomatic patients.

Results

Starting from 1233 eligible citations, 18 articles, including 7516 patients, were left. The pooled sensitivity was 54% for UGI (95% CI 34–74) with a high heterogeneity (I2 = 99.8%, p < .001), whereas CT scan showed a pooled sensitivity of 91% (95% CI 89–93) significantly higher than sensitivity of UGI series (p < 0.01), with a high heterogeneity (I2 = 98.9%, p < .001). In symptomatic patients the pooled sensitivity of UGI series was significantly lower than sensitivity of CT scan [49% (95% CI 31–68) vs 94% (95% CI 92–96), p < 0.01]. PPV showed a significant difference between UGI series and CT scan (54 vs 100%, p < 0.01). Specificity for UGI series was 98.6%, and specificity for CT scan was 99.7% (p = ns); the mean NPV was 96 and 98% for UGI series and CT scan (p = ns).

Conclusions

According to our results, a CT scan triggered by clinical suspicion must be considered the first-line procedure to detect a postoperative leak following primary sleeve gastrectomy or Roux-en-Y gastric bypass.
Appendix
Available only for authorised users
Literature
1.
Milone M, De Placido G, Musella M, et al. Incidence of successful pregnancy after weight loss interventions in infertile women: a systematic review and meta-analysis of the literature. Obes Surg. 2016;26:443–51.
2.
Bray GA, Frühbeck G, Ryan DH, et al. Management of obesity. Lancet. 2016;387(10031):1947–56.
3.
Milone M, Elmore U, Di Salvo E, et al. Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers. Surg Endosc. 2015;29:2314–20.CrossRefPubMed
4.
5.
Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis. 2014;10:713–23.
6.
Musella M, Milone M, Bianco P, et al. Acute leaks following laparoscopic sleeve gastrectomy: early surgical repair according to a management algorithm. J Laparoendosc Adv Surg Tech A. 2016;26:85–91.
7.
Quartararo G, Facchiano E, Scaringi S, et al. Upper gastrointestinal series after Roux-en-Y gastric bypass for morbid obesity: effectiveness in leakage detection. A systematic review of the literature. Obes Surg. 2014;24:1096–101.
8.
Gagner M, Deitel M, Erickson AL, et al. Survey on laparoscopic sleeve gastrectomy (LSG) at the fourth international consensus summit on sleeve gastrectomy. Obes Surg. 2013;23:2013–7.
9.
Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014. Obes Surg. 2017;27:2279–89.
10.
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.
11.
12.
13.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.CrossRefPubMed
14.
Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.
15.
Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.
16.
Blachar A, Federle MP, Pealer KM, et al. Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology. 2002;223(3):625–32.
17.
Carter JT, Tafreshian S, Campos GM, et al. Routine upper GI series after gastric bypass does not reliably identify anastomotic leaks or predict stricture formation. Surg Endosc. 2007;21:2172–7.
18.
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.
19.
Fuks D, Verhaeghe P, Brehant O, et al. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery. 2009;145:106–13.
20.
Schiesser M, Guber J, Wildi S, et al. Utility of routine versus selective upper gastrointestinal series to detect anastomotic leaks after laparoscopic gastric bypass. Obes Surg. 2011;21(8):1238–42.
21.
Gentileschi P, Camperchioli I, D'Ugo S, et al. Staple-line reinforcement during laparoscopic sleeve gastrectomy using three different techniques: a randomized trial. Surg Endosc. 2012;26(9):2623–9.
22.
Warschkow R, Tarantino I, Folie P, et al. C-reactive protein 2 days after laparoscopic gastric bypass surgery reliably indicates leaks and moderately predicts morbidity. J Gastrointest Surg. 2012;16:1128–35.
23.
Gnecchi M, Bella G, Pino AR, et al. Usefulness of x-ray in the detection of complications and side effects after laparoscopic sleeve gastrectomy. Obes Surg. 2013;23:456–9.
24.
Mittermair R, Sucher R, Perathoner A. Results and complications after laparoscopic sleeve gastrectomy. Surg Today. 2014;44:1307–12.CrossRefPubMed
25.
Romain B, Chemaly R, Meyer N, et al. Diagnostic markers of postoperative morbidity after laparoscopic Roux-en-Y gastric bypass for obesity. Langenbeck’s Arch Surg. 2014;399:503–8.
26.
Wahby M, Salama AF, Elezaby AF, et al. Is routine postoperative gastrografin study needed after laparoscopic sleeve gastrectomy? Experience of 712 cases. Obes Surg. 2013;23:1711–7.
27.
Moon RC, Shah N, Teixeira AF, et al. Management of staple line leaks following sleeve gastrectomy. Surg Obes Relat Dis. 2015;11:54–9.
28.
Arteaga-González I, Martín-Malagón A, Martín-Pérez J, et al. Usefulness of clinical signs and diagnostic tests for suspected leaks in bariatric surgery. Obes Surg. 2015;25:1680–4.
29.
Bingham J, Shawhan R, Parker R, et al. Computed tomography scan versus upper gastrointestinal fluoroscopy for diagnosis of staple line leak following bariatric surgery. Am J Surg. 2015;209:810–4.
30.
Mizrahi I, Tabak A, Grinbaum R, et al. The utility of routine postoperative upper gastrointestinal swallow studies following laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(9):1415–9.
31.
Delhom E, Nougaret S, Nocca D, et al. Routine postoperative upper gastrointestinal fluoroscopy after laparoscopic sleeve gastrectomy: is there still a utility? Diagn Interv Imaging. 2015;96:947–51.
32.
Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7.
33.
Carandina S, Tabbara M, Bossi M, et al. Staple line reinforcement during laparoscopic sleeve gastrectomy: absorbable monofilament, barbed suture, fibrin glue, or nothing? Results of a prospective randomized study. J Gastrointest Surg. 2016;20:361–6.
34.
Gagner M. Decreased incidence of leaks after sleeve gastrectomy and improved treatments. Surg Obes Rel Dis. 2014;10:611–2.
35.
Kim J, Azagury D, Eisenberg D, et al. American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis. 2015;11:739–48.
36.
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.
37.
Leslie DB, Dorman RB, Anderson J, et al. Routine upper gastrointestinal imaging is superior to clinical signs for detecting gastrojejunal leak after laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg. 2012;214:208–13.
38.
Rebibo L, Dhahri A, Badaoui R, et al. Laparoscopic sleeve gastrectomy as day-case surgery (without overnight hospitalization). Surg Obes Relat Dis. 2015;11:335–42.
39.
Khorgami Z, Petrosky JA, Andalib A, et al. Fast track bariatric surgery: safety of discharge on the first postoperative day after bariatric surgery. Surg Obes Relat Dis. 2017;13:273–80.
40.
Fridman A, Moon R, Cozacov Y, et al. Procedure-related morbidity in bariatric surgery: a retrospective short- and mid-term follow-up of a single institution of the American College of Surgeons Bariatric Surgery Centers of Excellence. J Am Coll Surg. 2013;217:614–20.
41.
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;22:1039–43.
42.
Terterov D, Leung PH, Twells LK, et al. The usefulness and costs of routine contrast studies after laparoscopic sleeve gastrectomy for detecting staple line leaks. Can J Surg. 2017;60:335–41.
43.
Aurora AL, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509–15.CrossRefPubMed
44.
Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27:240–5.
45.
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.
46.
Esmailzadeh H, Powell W, Lourie D. Use of computed tomography in diagnosis of major postoperative gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery. Am Surg. 2004;70:964–6.PubMed
47.
Carucci LR, Turner MA, Yu J. Imaging evaluation following Roux-en-Y gastric bypass surgery for morbid obesity. Radiol Clin N Am. 2007;45:247–60.CrossRefPubMed
48.
49.
Bertelson NL, Myers JA. Routine postoperative upper gastrointestinal fluoroscopy is unnecessary after laparoscopic adjustable gastric band placement. Surg Endosc. 2010;24:2188–91.CrossRefPubMed
50.
Mbadiwe T, Prevatt E, Duerinckx A, et al. Assessing the value of routine upper gastrointestinal contrast studies following bariatric surgery: a systematic review and meta-analysis. Am J Surg. 2015;209:616–22.
Metadata
Title
Efficacy of Postoperative Upper Gastrointestinal Series (UGI) and Computed Tomography (CT) Scan in Bariatric Surgery: a Meta-analysis on 7516 Patients
Authors
Mario Musella
Valeria Cantoni
Roberta Green
Wanda Acampa
Nunzio Velotti
Paola Maietta
Alberto Cuocolo
Publication date
01-08-2018
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-018-3172-5

Other articles of this Issue 8/2018

Obesity Surgery 8/2018 Go to the issue

Original Contributions

Preoperative and Postoperative Assessments of Biochemical Parameters in Patients with Severe Obesity Undergoing Laparoscopic Sleeve Gastrectomy

Original Contributions

Analyzing the Psychometric Properties of the Short Form-36 Quality of Life Questionnaire in Patients with Obesity

Original Contributions

Bariatric Surgery Improves Hyperandrogenism, Menstrual Irregularities, and Metabolic Dysfunction Among Women with Polycystic Ovary Syndrome (PCOS)

Original Contributions

Short-Term Results of Revisional Single-Anastomosis Gastric Bypass After Sleeve Gastrectomy for Weight Regain

Original Contributions

Which Bariatric Procedure Is the Most Popular in the World? A Bibliometric Comparison

Original Contributions

A Screening Study of Potential Carcinogen Biomarkers After Surgical Treatment of Obesity