Endoscopy and upper gastrointestinal contrast studies are complementary in evaluation of weight regain after bariatric surgery

Abstract

Background 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 the UGI study. On the basis of these findings and the dietary evaluation, 23 patients (77%) were offered a revisional procedure. Conclusion 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.