title: Utility of barium studies for patients with recurrent weight gain after Roux-en-Y gastric bypass.
abstract: OBJECTIVE
  To determine the utility of barium studies for detecting abnormalities responsible for recurrent weight gain after gastric bypass surgery.
  
  
  METHODS
  A computerized search identified 42 patients who had undergone barium studies for recurrent weight gain after gastric bypass and 42 controls. The images were reviewed to determine the frequency of staple-line breakdown and measure the length/width of the pouch and gastrojejunal anastomosis. A large pouch exceeded 6 cm in length or 5 cm in width and a wide anastomosis exceeded 2 cm. Records were reviewed for the amount of recurrent weight gain and subsequent weight loss after additional treatment.
  
  
  RESULTS
  Staple-line breakdown was present in 6/42 patients (14%) with recurrent weight gain. When measurements were obtained, 13/35 patients (37%) with recurrent weight gain had a large pouch, three (9%) had a wide anastomosis, and four (11%) had both, whereas 22/42 controls (52%) had a large pouch, one (2%) had a wide anastomosis, and two (5%) had both. Ten patients (24%) with recurrent weight gain underwent staple-line repair (n = 3) or pouch/anastomosis revision (n = 7). These 10 patients had a mean weight loss of 38.1 lbs versus a mean loss of 8.6 lbs in 19 patients managed medically.
  
  
  CONCLUSIONS
  Only 14% of patients with recurrent weight gain after gastric bypass had staple-line breakdown, whereas 57% had a large pouch, wide anastomosis, or both. Not all patients with abnormal anatomy had recurrent weight gain, but those who did were more likely to benefit from surgical intervention than from medical management.
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: B
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. Electronic address: marc.levine@uphs.upenn.edu.
authors.forename: M S
authors.initials: MS
authors.lastname: Levine
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Rubesin
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: N N
authors.initials: NN
authors.lastname: Williams
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: K
authors.initials: K
authors.lastname: Dumon
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: S
authors.initials: S
authors.lastname: Raper
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects*; D001466:Barium Sulfate; D016022:Case-Control Studies; D003287:Contrast Media; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology / Q000601:surgery; D017792:Surgical Stapling / Q000009:adverse effects*; D017211:Treatment Failure; D015430:Weight Gain; D015431:Weight Loss
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate