EGD and UGI Contrast Studies of Weight Regain
EGD and UGI Contrast Studies of Weight Regain
Abstract & Commentary
By Richard Peterson, MD, MPH, Clinical Instructor of Surgery, Department of Surgery, USC. Dr. Peterson reports no financial relationship relevant to this field of study.
Synopsis: EGD and UGI contrast studies are complementary in the evaluation of patients with weight regain after bariatric surgery.
Source: Brethauer SA, et al. Endoscopy and upper gastrointestinal contrast studies are complementary in evaluation of weight regain after bariatric surgery. Surg Obes Relat Dis. 2006;2:643-648.
To assess the utility of upper endoscopy (EGD) and upper gastrointestinal (UGI) contrast studies in the evaluation of weight regain after previous bariatric surgery.
Methods: We retrospectively reviewed the findings of EGD and UGI studies for patients referred to our center for weight regain after bariatric surgery. All patients received a dietary assessment concomitant with the anatomic evaluations.
Results: From January 2003 and March 2006, 30 patients qualified for the study (25 women and 5 men, average age 49 years). Of the 30 patients, 16 had undergone gastroplasty and 14 open Roux-en-Y gastric bypass. Of the 30 patients, 27 (90%) had ≥ 1 abnormality detected on UGI study or EGD. Of these abnormalities, 10 were gastrogastric fistulas, 8 of which were detected with both UGI study and EGD; 11 dilated pouches were diagnosed by EGD but only 2 were also diagnosed on the UGI study. An enlarged stoma size was diagnosed in 7 patients (6 by EGD and 1 on the UGI study). Also, the UGI study diagnosed 1 Roux limb and 7 esophageal abnormalities not seen on EGD and EGD diagnosed 4 esophageal and 3 gastric abnormalities not seen on UGI study. On the basis of these findings and the dietary evaluation, 23 patients (77%) were offered a revisional procedure.
Commentary
EGD and UGI contrast studies are complementary in the evaluation of patients with weight regain after bariatric surgery. The combination of the 2 studies detected all the gastrogastric fistulas present. EGD provided more useful pouch and stomal information, and the UGI study detected esophageal or Roux limb abnormalities that frequently require additional evaluation.
Brethauer and colleagues present a nice evaluation of patients following surgery for morbid obesity with weight gain. The Roux-en-Y gastric bypass is the current surgical gold standard for morbid obesity. It provides a durable weight loss for most patients, but Shikora et al cite a 10-15% failure of weight loss and or weight recividism. The causes of weight regain after surgery may be either behavioral or anatomic or a combination of the two.
Accordingly one of the most common indications for repeat bariatric surgery is insufficient weight loss or weight regain. There is data suggesting that revisional surgery is appropriate either when an anatomic abnormality has been identified or when behavioral issues such as grazing, binging, sweet eating or other behavioral issues have been ruled out. The change to a different procedure may provide a benefit to patients and the most success has been with the use of a salvage Roux-en-Y gastric bypass.
This study emphasizes the importance of evaluation of the most common causes of obesity surgery failure. In fact EGD or UGI studies in and of themselves are moderately accurate at detecting problems, but in combination are much more sensitive and specific. Brethauer et al, after evaluating their data, concluded that each of the 2 modalities was better at individually identifying:
EGD:
Pouch size
Stoma size
UGI:
Esophageal abnormalities
Roux limb abnormalities
However, Brethauer et al were able to put together the information from both studies and have more precise information. In fact, all of the gastrogastric fistulas were identified with the combination of the 2 studies.
Brethauer et al have provided us with information supporting the use of 2 studies in evaluation of patients who have failed after a bypass operation. They also emphasize the evaluation of patient behaviors in addition to ruling out anatomic causation.
EGD and UGI contrast studies are complementary in the evaluation of patients with weight regain after bariatric surgery.Subscribe Now for Access
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