Department of Radiology, Harlem Hospital Center, New York, New York; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York.
Department of Radiology, Harlem Hospital Center, New York, New York.
Surg Obes Relat Dis. 2017 Aug;13(8):1327-1336. doi: 10.1016/j.soard.2017.04.031. Epub 2017 Apr 29.
A lack of well-defined postoperative imaging guidelines for bariatric patients may lead to false-positive findings, radiation exposure, additional cost, and patient anxiety. We investigated our institutional usage and utility of nonroutine postoperative abdominal imaging.
Laparoscopic gastric bypass and sleeve gastrectomy patients over a 5-year period were retrospectively identified. All bariatric-related nonroutine initial and all subsequent prompted abdominal and pelvic imaging was included.
A total of 578 patients were included (399 gastric bypass, 179 sleeve gastrectomy); 907 nonroutine studies in 69% of patients were performed, and 36% patients underwent computed tomography (CT). Only 20.3% of findings were symptom-related, 26% had benign incidental findings, and 50% were negative. Incidental findings prompted 71 additional studies. Bypass procedure (sleeve versus bypass, odds ratio [OR] .3), older age (median 43 versus 48 years), and lower initial body mass index (BMI) (median 43 versus 45) increased the likelihood of imaging. History of prior abdominal surgery and dyspepsia increased the probability of undergoing CT by an odds ratio of 1.8 and 2.0, respectively (P<.05). History of ulcer (OR .6) or reflux on routine upper gastrointestinal imaging (OR .3) decreased probability (P<.05). Patients who underwent CT were more likely to undergo other abdominal imaging (3 versus 1 study per patient, P<.01).
Postoperative abdominal imaging in the bariatric population is common, with almost 70% of patients undergoing imaging and 70% of findings not related to patient symptoms. Bypass procedure, older age, and lower initial BMI were associated with a higher likelihood of patients undergoing imaging. Heightened understanding of this important subject is necessary to help streamline cost-effective imaging protocols for these patients.
缺乏明确的减重术后影像学指南可能导致假阳性结果、辐射暴露、额外费用和患者焦虑。我们调查了我们机构对非常规术后腹部影像学的使用和实用性。
回顾性地确定了 5 年内接受腹腔镜胃旁路手术和袖状胃切除术的患者。所有与减重相关的非常规初始和所有后续提示的腹部和骨盆影像学均包括在内。
共纳入 578 例患者（胃旁路 399 例，袖状胃切除术 179 例）；69%的患者进行了 907 次非常规检查，其中 36%的患者接受了计算机断层扫描（CT）。只有 20.3%的发现与症状相关，26%的发现为良性偶然发现，50%的发现为阴性。偶然发现提示进行了 71 次额外的研究。旁路手术（袖状胃切除术与胃旁路术相比，比值比[OR].3）、年龄较大（中位数 43 岁与 48 岁）和初始体重指数（BMI）较低（中位数 43 岁与 45 岁）增加了影像学检查的可能性。既往腹部手术史和消化不良史使接受 CT 的可能性分别增加了 1.8 倍和 2.0 倍（P<.05）。上消化道常规影像学检查有溃疡史（OR.6）或反流史（OR.3）降低了可能性（P<.05）。接受 CT 检查的患者更有可能接受其他腹部影像学检查（每位患者 3 次与 1 次检查，P<.01）。
减重人群的腹部影像学检查很常见，近 70%的患者接受影像学检查，70%的检查结果与患者症状无关。旁路手术、年龄较大和初始 BMI 较低与患者接受影像学检查的可能性增加有关。为了帮助为这些患者制定成本效益高的影像学方案，需要充分了解这一重要课题。
