Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, 13210, USA.
Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA.
Obes Surg. 2024 May;34(5):1552-1560. doi: 10.1007/s11695-024-07125-4. Epub 2024 Apr 2.
To investigate usage and utility of routine upper gastrointestinal (UGI) series in the immediate post-operative period to evaluate for leak and other complications.
Single institution IRB-approved retrospective review of patients who underwent bariatric procedure between 01/08 and 12/12 with at least 6-month follow-up.
Out of 135 patients (23%) who underwent routine UGI imaging, 32% of patients were post-gastric bypass (127) versus 4% of sleeve gastrectomy (8). In patients post-gastric bypass, 22 were found with delayed contrast passage, 3 possible obstruction, 4 possible leak, and only 1 definite leak. In patients post-sleeve gastrectomy, 2 had delayed passage of contrast without evidence of a leak. No leak was identified in 443 patients (77%) who did not undergo imaging. The sensitivity and specificity of UGI series for the detection of leak in gastric bypass patients were 100% and 97%, respectively, and the positive and negative predictive values were 20% and 100%, respectively. On univariate and multivariate analysis, sleeve gastrectomy patients (OR 0.4 sleeve vs bypass; P < 0.01) and male patients (OR 0.4 M vs F; P 0.02) were less likely to undergo routine UGI series (OR 0.4 M vs F; P 0.02).
Routine UGI series may be of limited value for the detection of anastomotic leaks after gastric bypass or sleeve gastrectomy and patients should undergo routine imaging based on clinical parameters. Gastric bypass procedure and female gender were factors increasing the likelihood of routine post-operative UGI. Further larger scale analysis of this important topic is warranted.
研究在术后即刻进行常规上消化道（UGI）系列检查以评估漏诊和其他并发症的使用情况和实用性。
对 2008 年 1 月至 2012 年 12 月期间在我院接受减重手术且至少有 6 个月随访的患者进行单机构 IRB 批准的回顾性研究。
在接受常规 UGI 影像学检查的 135 例患者中（23%），胃旁路术（127 例）后进行 UGI 检查的患者占 32%，袖状胃切除术（8 例）后进行 UGI 检查的患者占 4%。在胃旁路术后患者中，22 例患者发现造影剂延迟通过，3 例可能存在梗阻，4 例可能存在漏诊，仅有 1 例明确漏诊。在袖状胃切除术后患者中，2 例患者造影剂通过延迟，但无漏诊证据。未行影像学检查的 443 例患者中未发现漏诊。胃旁路术后患者 UGI 系列检查对漏诊的敏感性和特异性分别为 100%和 97%，阳性和阴性预测值分别为 20%和 100%。单因素和多因素分析显示，袖状胃切除术患者（比值比 0.4 袖 vs 旁路；P<0.01）和男性患者（比值比 0.4 M vs F；P<0.02）不太可能进行常规 UGI 系列检查（比值比 0.4 M vs F；P<0.02）。
常规 UGI 系列检查对胃旁路术或袖状胃切除术吻合口漏的检测可能价值有限，患者应根据临床参数进行常规影像学检查。胃旁路术和女性是增加常规术后 UGI 可能性的因素。需要进一步更大规模地分析这一重要问题。
