title: Routine postoperative upper gastrointestinal fluoroscopy after laparoscopic sleeve gastrectomy: Is there still a utility?
abstract: OBJECTIVE
  To assess the performance of routine esophagogastric transit studies (OGT) performed between day 2 (D2) and day 4 (D4) following sleeve gastrectomy for the diagnosis of gastric fistula.
  
  
  METHODS
  Single center study including 736 patients undergoing surgery for sleeve gastrectomy including 32 of whom developed gastric fistula. Seven hundred and twenty OGT on D2 and 86 abdominal and pelvic CT scans were performed to investigate for a fistula and whether or not a blood collection was present. Sensitivity, specificity, positive and negative predictive values, Youden index (YI) and dosimetry were calculated for both investigations.
  
  
  RESULTS
  The sensitivity and specificity of OGT for the diagnosis of fistula were 7% and 98% respectively with a PPV of 18%, an NPV of 96% and YI of 0.06. The mean DSP was 5500μGy.m(2). Sensitivity, specificity, positive and negative predictive values and Youden index for CT were 55%, 100%, 100%, 81%, 0.55, respectively for the presence of a fistula; and 96%, 86%, 78%, 98%, 0.83 for the presence of a non-blood collection and; 100%, 86%, 78%, 100%, 0.86 for the presence of a non-blood collection and/or fistula. The mean DLP was 3700 mGy.cm.
  
  
  CONCLUSIONS
  Because of its very poor sensitivity for the diagnosis of gastric fistula, the OGT on D2 needs to be reconsidered. CT performed on clinical suspicion appears to be a better diagnostic tool.
authors: Department of medical imaging, Saint-Éloi, Montpellier university hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France. Electronic address: e-delhom@chu-montpellier.fr.
authors: E
authors: E
authors: Delhom
authors: Department of medical imaging, Saint-Éloi, Montpellier university hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
authors: S
authors: S
authors: Nougaret
authors: Department of gastrointestinal surgery A, Saint-Éloi, Montpellier university hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
authors: D
authors: D
authors: Nocca
authors: Department of gastrointestinal surgery A, Saint-Éloi, Montpellier university hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
authors: M
authors: M
authors: Skali
authors: Department of medical imaging, Saint-Éloi, Montpellier university hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
authors: M-A
authors: MA
authors: Pierredon
authors: Department of medical imaging, Saint-Éloi, Montpellier university hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
authors: B
authors: B
authors: Guiu
authors: Department of medical imaging, Saint-Éloi, Montpellier university hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France; MUHC, department of medical imaging, Mc Gill university, Montpellier, Canada.
authors: B
authors: B
authors: Gallix
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000000981:diagnostic imaging; D005471:Fluoroscopy / Q000379:methods*; D005747:Gastric Fistula / Q000000981:diagnostic imaging*; D005772:Gastrointestinal Transit / Q000502:physiology*; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011829:Radiation Dosage; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: CT; Esophageal transit; Fistula; Obese; Sleeve gastrectomy