title: Post Roux-en-Y gastric bypass complications: A comparative study assessing the clinical effectiveness of oesophagogastroduodenoscopy and oral-contrast swallow.
abstract: BACKGROUND
  Anastomotic strictures at the gastrojejunal anastomosis have been reported to occur in 3-20% of patients following a Roux-en-Y gastric bypass (RYGB). Patients commonly present with dysphagia, vomiting and post-prandial pain. Clearly using the appropriate investigations to diagnose the potential complications have both clinical and economical benefits. The reported study compared whether Oesophagogastroduodenoscopy (OGD) or oral-contrast swallow should be employed in patient presenting with post-operative complications following RYGB.
  
  
  METHODS
  A retrospective study was conducted on 112 patients between 2008 and 2012; at a level 4 bariatric surgery hospital. Patients who had ≥1 OGD to investigate a post-operative complication were included for analysis. Oral-contrast swallow radiology reports performed <28 days prior to an OGD were included for analysis. Patient demographics, OGD, oral-contrast swallow and additional interventions reports were collated from electronic records, pathology and radiology results.
  
  
  RESULTS
  112 patients underwent 1 or more OGD. 75% (n = 67) of patients were diagnosed with a post-operative complication with the most common, 51% (n = 57) being a gastrojejunal anastomotic stricture. 82% (n = 47) of patients presented with dysphagia + - vomiting prior to the diagnosis of gastrojejunal anastomotic strictures. 96% (n = 55) of patients with gastrojejunal anastomotic strictures were successfully treated with balloon dilation. 48% (n = 54) of patients had an oral-contrast swallow as a first line investigation for post-operative symptoms prior to the OGD. 15% (n = 8) of oral-contrast swallow were reported with a significant pathology, with only 1 stricture identified. 70% (n = 38) of oral-contrast swallows reported as normal had a pathology identified at OGD, including 28 strictures.
  
  
  CONCLUSIONS
  We recommend that an OGD should be performed in patients presenting with symptoms consistent with a stricture following RYGB. The urgency of the OGD will be dictated by clinical correlation. The use of a water-soluble contrast swallow should be reserved for a suspected anastomotic leak.
authors.affiliation: Walsall Manor Hospital, West Midlands, WS2 9PS, UK. Electronic address: Prashant.Patel225@gmail.com.
authors.forename: Prashant
authors.initials: P
authors.lastname: Patel
authors.affiliation: Walsall Manor Hospital, West Midlands, WS2 9PS, UK. Electronic address: balsin@hotmail.com.
authors.forename: Ricky
authors.initials: R
authors.lastname: Bhogal
authors.affiliation: Walsall Manor Hospital, West Midlands, WS2 9PS, UK. Electronic address: amit.rajput@nhs.net.
authors.forename: Amit
authors.initials: A
authors.lastname: Rajput
authors.affiliation: Walsall Manor Hospital, West Midlands, WS2 9PS, UK. Electronic address: bariatric.services@walsallhealthcare.nhs.uk.
authors.forename: Ana
authors.initials: A
authors.lastname: Elshaw
authors.affiliation: Walsall Manor Hospital, West Midlands, WS2 9PS, UK. Electronic address: priyo.sada@walsallhealthcare.nhs.uk.
authors.forename: Priyo
authors.initials: P
authors.lastname: Sada
authors.affiliation: Walsall Manor Hospital, West Midlands, WS2 9PS, UK. Electronic address: Amir.khan@walsallhealthcare.nhs.uk.
authors.forename: Amir
authors.initials: A
authors.lastname: Khan
authors.affiliation: Walsall Manor Hospital, West Midlands, WS2 9PS, UK. Electronic address: Salman.mirza@walsallhealthcare.nhs.uk.
authors.forename: Salman
authors.initials: S
authors.lastname: Mirza
mesh_terms: D000284:Administration, Oral; D003287:Contrast Media / Q000008:administration & dosage; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media
keywords: Complications; Dysphagia; OGD; Oral-contrast swallow; RYGB; Strictures