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Gastrointestinal Imaging

E2749. The Skinny on Bariatric Interventions

Laste Z,  Wein M. Medical College of Wisconsin, Milwaukee, WI

Address correspondence to m. wein (mwein@mcw.edu)

Background Information: The obesity epidemic continues to worsen in the United States. Numerous comorbidities are associated with excess body weight, leading to ill health and soaring healthcare costs. Patients continue to search for solutions in an obesogenic environment where excess food and sedentary lifestyles are the norm. Over the last decade, numerous surgical and, more recently, less invasive solutions have been offered. It is essential that the radiologist be well-versed in these bariatric procedures as complications are not uncommon and may be encountered on imaging obtained in the emergency, clinic, or inpatient setting.

Educational Goals/Teaching Points: The purpose of this exhibit is to not only review the basic anatomy and complications of well-established bariatric procedures (Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric banding), but to introduce more recent interventions that may be unfamiliar to the radiologist. Viewers of this exhibit will be able to recognize complications of widely accepted procedures as well as new, sporadically encountered methods.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Our exhibit reviews normal bariatric surgery anatomy and complications in patients having undergone Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy. Complications include but are not limited to anastomotic leaks, gastrogastric fistulas, and band slippage and erosion. Additionally, endoscopic intragastric balloon procedures will be discussed. Finally, aspiration techniques performed via an endoscopically placed gastrostomy tube will be introduced.

Conclusion: Bariatric interventions are becoming commonplace as the obesity epidemic continues to grow. Radiologists must be aware of the normal anatomy after bariatric surgery and complications related to well-established and newer techniques. We review the well-established techniques, their normal anatomy, and potential complications, and introduce the intragastric balloon and aspiration techniques performed via an endoscopically placed gastrostomy tube.