Musella Mario, Cantoni Valeria, Green Roberta, Acampa Wanda, Velotti Nunzio, Maietta Paola, Cuocolo Alberto
Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy.
Obes Surg. 2018 Aug;28(8):2396-2405. doi: 10.1007/s11695-018-3172-5.
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.
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.
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 (I = 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 (I = 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).
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.
为了证明常规早期术后上消化道造影（UGI）在接受减肥手术的肥胖患者中的无用性和无效性，并表明在临床怀疑有渗漏的情况下CT扫描具有更高的有效性，我们进行了一项荟萃分析。
进行文献检索，包括过去18年发表的文章。对于UGI和CT扫描，计算了敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。第一次分析考虑所有患者，第二次分析仅考虑有症状的患者。
从1233条符合条件的引文中筛选出18篇文章，共7516例患者。UGI的合并敏感性为54%（95%CI 34 - 74），异质性高（I = 99.8%，p < 0.001），而CT扫描的合并敏感性为91%（95%CI 89 - 93），显著高于UGI系列的敏感性（p < 0.01），异质性也高（I = 98.9%，p < 0.001）。在有症状的患者中，UGI系列的合并敏感性显著低于CT扫描[49%（95%CI 31 - 68）对94%（95%CI 92 - 96），p < 0.01]。PPV在UGI系列和CT扫描之间显示出显著差异（54对100%，p < 0.01）。UGI系列的特异性为98.6%，CT扫描的特异性为99.7%（p = 无统计学意义）；UGI系列和CT扫描的平均NPV分别为96%和98%（p = 无统计学意义）。
根据我们的结果，对于初次袖状胃切除术或Roux - en - Y胃旁路术后检测术后渗漏，临床怀疑触发的CT扫描应被视为一线检查方法。
