Radiologic assessment of the upper gastrointestinal tract: does it play an important preoperative role in bariatric surgery?
BACKGROUND
The role of upper GI series (UGIS) before bariatric surgery is controversial. The aim of this study was to evaluate the diagnostic yield and cost of routine UGIS prior to bariatric surgery.


METHODS
The medical records of consecutive obese patients who underwent UGIS before bariatric surgery between April 2001 and October 2002 were reviewed. UGIS reports were reviewed by 2 experienced gastroenterologists, and the findings were divided into 4 groups based on predetermined criteria: group 0 (normal study), group 1 (abnormal findings that neither changed the surgical approach nor postponed surgery), group 2 (abnormal findings that changed the surgical approach or postponed surgery), and group 3 (results which were an absolute contraindication to surgery). Clinically important findings included lesions in groups 2 and 3. The cost of an upper GI series (154.80 USD) was estimated from the published 2002 New York State Medicare reimbursement schedule.


RESULTS
During the 18-month study period, 171 patients were evaluated by UGIS prior to bariatric surgery. One or more lesions were identified in 48.0% of patients, with only 5.3% having clinically important findings. The prevalence of radiologic findings using the classification system above was as follows: group 0 (52.0%), group 1 (42.7%), group 2 (5.3%), and group 3 (0.0%). The most common findings identified were esophageal reflux (21.6%) and hiatal hernias (18.7%). The cost of performing routine UGIS on all patients before bariatric surgery was 2,941.20 USD per clinically important finding detected.


CONCLUSIONS
Routine preoperative upper GI series before bariatric surgery had a low diagnostic yield, rarely revealing pathology that changed the surgical approach or postponed surgery.
Sharaf
Ravi N
RN
Division of Gastroenterology and Department of Surgery, New York University School of Medicine, New York, NY, USA.
Weinshel
Elizabeth H
EH
Bini
Edmund J
EJ
Rosenberg
Jonathan
J
Ren
Christine J
CJ
D000328:Adult; D003365:Costs and Cost Analysis; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging* / Q000191:economics*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000191:economics; D011859:Radiography; D041742:Upper Gastrointestinal Tract / Q000000981:diagnostic imaging* / Q000503:physiopathology