Scientific Session 02 — Gastrointestinal - BowelMonday, May 1, 2017
1016. Routine Upper Gastrointestinal Series After Bariatric Surgery: Predictors, Usage and Utility
Haddad D1,2*, David A1, Abdel-Dayem H1, Ahmed L1, Gilet A3 1. Harlem Hospital Center, New York, NY; 2. Memorial Sloan Kettering Cancer Center, New York, NY; 3. Westchester Medical Center, Valhalla, NY
Address correspondence to D. Haddad (email@example.com)
Objective: Routine upper gastrointestinal imaging (UGI) is often utilized in the immediate postoperative period for patients who had bariatric surgery to evaluate for anastomotic leak and other complications. However, the value of routine UGI is controversial. We investigated our institutional usage and utility of postoperative routine UGI series.
Materials and Methods: All patients who underwent gastric bypass or sleeve gastrectomy over a 5-year period were identified retrospectively. All routine postoperative UGI series and detected complications were analyzed.
Results: A total of 578 patients were included. Routine UGI series was performed in 135 (23%) patients, including 127 of 399 (32%) patients who had gastric bypass and only 8 of 179 (4%) patients who had sleeve gastrectomy. In patients with gastric bypass, 30 complications were detected: 22 patients had delayed contrast material passage, three had possible obstruction, four had possible leak, and only one had definite leak detected and confirmed on exploratory laparoscopy. One patient with possible leak had a follow-up UGI series that was negative, and the three others were observed and discharged. In patients with sleeve gastrectomy, two had delayed passage of contrast material without evidence of leak. The overall sensitivity and specificity of UGI series for the detection of leak in patients with gastric bypass were 100% and 97%, and the positive and negative predictive values were only 20% and 100%, respectively. In univariate and multivariate analyses, patients who had sleeve gastrectomy (sleeve vs bypass odds ratio [OR], 0.4; p < 0.01) or were male (OR, 0.4; p = 0.02) were less likely to undergo routine UGI. Patients who underwent routine UGI were also more likely to undergo other postoperative nonroutine imaging studies (median, two studies vs one study; p < 0.01).
Conclusion: Routine UGI series may be of limited value for the detection of anastomotic leaks after bariatric surgery. Gastric bypass and female sex were factors increasing likelihood of routine postoperative UGI. Diagnosis may be better obtained using clinical parameters and selective UGI series. Further larger scale analysis is warranted.