Accuracy of upper gastrointestinal swallow study in identifying strictures after laparoscopic gastric bypass surgery.
BACKGROUND
Stricture at the gastrojejunal anastomosis after Roux-en-Y gastric bypass is a significant sequela that often requires intervention. The diagnosis of stricture is usually established by a recognized constellation of symptoms, followed by contrast radiography or endoscopy. The purpose of this report was to evaluate the accuracy of contrast swallow studies in excluding the diagnosis of gastrojejunal stricture.


METHODS
A retrospective analysis of the charts of 119 patients who had undergone laparoscopic Roux-en-Y gastric bypass, representing 41 upper gastrointestinal (GI) swallow studies, was conducted. Of those patients who underwent GI swallow studies, 30 then underwent definitive upper endoscopy to confirm or rule out stricture. The overall sensitivity, specificity, and negative predictive value of the swallow studies were calculated.


RESULTS
Of the 30 patients who underwent upper endoscopic examination for symptoms of stricture after laparoscopic gastric bypass, 20 were confirmed to have a stricture. The sensitivity, specificity, and negative predictive value of the upper GI swallow study in this group was 55%, 100%, and 53%, respectively. The demographics of the patients with strictures were similar to those of the study group as a whole.


CONCLUSIONS
The results of our study have shown that a positive upper GI swallow study is 100% specific for the presence of stricture. However, the sensitivity and negative predictive value of upper GI swallow studies were poor, making this modality unsatisfactory in definitively excluding the diagnosis of gastrojejunal stricture.
Department of Surgery, Section of Minimally Invasive Surgery, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA.
Rouzbeh
R
Daylami
Ann M
AM
Rogers
Tonya S
TS
King
Randy S
RS
Haluck
Timothy R
TR
Shope
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D001466:Barium Sulfate / Q000008:administration & dosage; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D003287:Contrast Media / Q000008:administration & dosage; D003974:Diatrizoate Meglumine / Q000008:administration & dosage; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D041742:Upper Gastrointestinal Tract / Q000000981:diagnostic imaging*
D003287:Contrast Media; D001466:Barium Sulfate; D003974:Diatrizoate Meglumine