The workup for bariatric surgery does not require a routine upper gastrointestinal series.
BACKGROUND
Morbid obesity is a serious disease that afflicts over five million Americans, threatening their health with such co-morbidities as diabetes, arthritis, pulmonary failure and stroke. Surgery is the only effective therapy, providing long-term control of weight, diabetes, pulmonary failure, and hypertension for as long as 14 years. Because the operation presents a major expense, this study examined whether X-ray examination of the gut could be omitted safely as a cost-saving measure.


METHODS
The records of 814 consecutive morbidly obese patients who underwent gastric bypass were reviewed to determine: (1) whether these individuals had undergone an upper gastro-intestinal (GI) series, and (2) if these studies influenced therapy or caused cancellation or postponement of surgery.


RESULTS
Of the 814 patients, 657 (80.7%) underwent a preoperative GI radiography. Of these examinations, 393 (59.8%) were normal, with the following abnormalities in the remaining 264: hiatal hernia, 164; esophageal reflux, 39; Schatzki's ring, 18; small bowel diverticula, four; renal stones, four; malrotation, three; gall stones, two; pyloric ulcer, one; possible pelvic mass, one; calcified leiomyoma, one; and dysphagial lusoria, one. None of these findings resulted in cancellation or a delay in surgery.


CONCLUSIONS
The upper GI series can be safely omitted from the routine preoperative evaluation of patients undergoing gastric bypass. At a cost of $741.00 per examination, this change represents significant potential savings. Similar evaluations of other routine preoperative tests may well provide a better basis for the evaluation of these complex patients.
Ghassemian
A J
AJ
The Department of Surgery, East Carolina University School of Medicine, Greenville, North Carolina 27858-4354, USA.
MacDonald
K G
KG
Cunningham
P G
PG
Swanson
M
M
Brown
B M
BM
Morris
P G
PG
Pories
W J
WJ
D000328:Adult; D017046:Cost Savings; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data*; D004064:Digestive System / Q000000981:diagnostic imaging*; D015390:Gastric Bypass / Q000191:economics; D006801:Humans; D009767:Obesity, Morbid / Q000000981:diagnostic imaging; D011300:Preoperative Care / Q000191:economics / Q000706:statistics & numerical data*; D011859:Radiography