Value of routine upper gastrointestinal swallow study after laparoscopic sleeve gastrectomy.
BACKGROUND
Gastric leak (GL) is one of the main early-onset postoperative complications of sleeve gastrectomy (SG). Many institutions perform routine upper gastrointestinal (UGI) contrast studies within 24 hours of surgery, looking for GL or gastric stenosis and to determine the need for urgent re-exploration, but this examination delays oral feeding, can cause side effects and is responsible for systematic and probably unnecessary irradiation of the patient.


OBJECTIVE
Determine the efficacy of routine UGI contrast studies to predict postoperative complications after SG in a large population.


METHODS
University hospital, France, public practice.


METHODS
This study consisted of retrospective review of a prospective database of a cohort of patients who underwent primary SG between January 2007 and August 2013 (n = 1137). Routine UGI contrast studies, performed on postoperative day 1, were independently reviewed by 2 radiologists. The primary endpoint of the study was the effect of routine UGI contrast study on detecting postoperative complications. The secondary endpoints were comparison of the findings of routine UGI contrast study and abdominal computed tomography (CT) scan, sensitivity, and specificity of different imaging signs on abdominal CT scan in the presence of GL, evaluation of the SG learning curve based on the findings of routine UGI contrast studies.


RESULTS
A total of 1137 patients underwent primary SG and 30 GL (2.6%) with a mean time to diagnosis of 23.4 days (1-245) and 15 cases of gastric stenosis (1.3%) were observed during the study period. Routine UGI study was performed in 1108 patients, whereas 29 patients were assessed by first-line CT scan. None of the 1108 UGI studies found a GL or gastric stenosis. In the 30 cases of GL, the most sensitive and specific sign was the presence of perigastric abscess without contrast material leak (sensitivity: 56.6%; specificity: 95%). The mean time interval between routine postoperative UGI contrast study and abdominal CT scan was 12.9 days (0-86). Uniform gastric shape was acquired after 30-32 SG procedures.


CONCLUSIONS
Routine postoperative UGI on postoperative day 1 is of limited value after SG. Abdominal CT scan should be preferred in the presence of clinical suspicion of postoperative complications. Selective UGI contrast study remains indicated when gastric stenosis is suspected and at the beginning of the SG learning curve.
Department of Radiology, Amiens University Hospital, Amiens, France.
Cyril
C
Chivot
Department of Digestive Surgery, Amiens University Hospital, Amiens, France.
Lionel
L
Rebibo
Department of Radiology, Amiens University Hospital, Amiens, France.
Brice
B
Robert
Department of Digestive Surgery, Amiens University Hospital, Amiens, France.
Abdennaceur
A
Dhahri
Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France. Electronic address: regimbeau.jean-marc@chu-amiens.fr.
Jean-Marc
JM
Regimbeau
Department of Radiology, Amiens University Hospital, Amiens, France.
Thierry
T
Yzet
D000293:Adolescent; D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D003287:Contrast Media; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D011182:Postoperative Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000000981:diagnostic imaging; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D003287:Contrast Media
Bariatric surgery; Complications; Gastric leak; Sleeve gastrectomy; Upper gastrointestinal contrast studies