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

Area of Science:

• Bariatric Surgery
• Gastrointestinal Imaging
• Surgical Complications

Background:

• Post-operative upper gastrointestinal (UGI) series are sometimes used to detect complications after bariatric procedures.
• The utility of routine UGI imaging in the immediate post-operative period requires further investigation.

Purpose of the Study:

• To evaluate the usage and diagnostic value of routine upper gastrointestinal (UGI) series for detecting leaks and other complications following bariatric surgery.
• To identify factors influencing the decision to perform routine post-operative UGI imaging.

Main Methods:

• Retrospective review of patients who underwent bariatric procedures (gastric bypass or sleeve gastrectomy) between 2008 and 2012.
• Analysis of routine UGI series findings, complications, and patient demographics.

Main Results:

• 135 patients (23%) received routine UGI imaging; 127 post-gastric bypass and 8 post-sleeve gastrectomy.
• UGI series identified only 1 definite leak in gastric bypass patients; no leaks were found in sleeve gastrectomy patients or in the 77% who did not undergo imaging.
• Sensitivity for leak detection was 100% but positive predictive value was only 20% in gastric bypass patients. Sleeve gastrectomy and male gender decreased likelihood of routine UGI.

Conclusions:

• Routine UGI series imaging has limited value for detecting anastomotic leaks after gastric bypass and sleeve gastrectomy.
• Post-operative imaging should be based on clinical parameters rather than routine protocols.
• Gastric bypass and female gender were associated with increased likelihood of routine UGI imaging; further research is warranted.