RESEARCH POSTER PRESENTATION DESIGN © 2012

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BACKGROUND: Roux-en-Y gastric bypass and sleeve gastrectomy (gastric sleeve) remain common procedures for treating morbid obesity(4). Of the possible postoperative complications, perhaps the most significant is an extra-luminal leak(1). Early detection is important given the potential of peritonitis and associated high mortality. Extravasation of barium into the peritoneum is also associated with peritonitis, a potentially life-threatening complication, thus gastrografin is currently the standard oral contrast medium used for detecting postoperative leaks given it is water-soluble properties; however its sole usage may be associated with high false negative rates. Barium sulfate, given its higher density and presumed greater adherence to sites of extra-luminal leakage has been postulated to be a better contrast agent for the detection of leaks(2, 5, 6). Consequently, many institutions begin with an upper-GI series using gastrografin, and if negative, do an immediate follow-up upper-GI examination using barium as the oral contrast agent. Our intention was to investigate whether or not a follow-up upper-GI exam using barium would increase the sensitivity of detecting postoperative leaks.

INTRODUCTION

METHODS

CONCLUSIONS

HYPOTHESIS: Follow-up barium upper-GI exams after an initial negative gastrografin exam will detect small leaks that would have otherwise gone undetected.

REFERENCES1. Carucci LR, Turner MA, et al. Roux-en-Y gastric bypass surgery for morbid obesity:

evaluation of postoperative extra-luminal leaks with upper gastrointestinal series. Radiology 2006; 238:119

2. Foley MJ, Ghahremani GG, et al. Reappraisal of contrast media used to detect upper gastrointestinal perforations: comparison of ionic water-soluble media with barium sulfate. Radiology 1982; 144:231

3. Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology 2014; 270:327

4. Merkle EM, Hallowell PT, et al. Roux-en-Y gastric bypass for clinically severe obesity: normal appearance and spectrum of complications at imaging. Radiology 2005; 234:674

5. Swanson JO, Levine MS, et al. Usefulness of high-density barium for detection of leaks after esophagogastrectomy, total gastrectomy, and total laryngectomy. AJR Am J Roentgenol 2003; 181:415

6. Tanomkiat W, Galassi W. Barium sulfate as contrast medium for evaluation of postoperative anastomotic leaks. Acta Radiol 2000; 41:482

CONTACTS

Derrick D. Wagoner, D.O. OGME-III – dwagoner@aomc.orgSaad Farooq, MS-III - Saad.Farooq@med.lecom.eduJoseph A. Ronsivalle, D.O.- jronsivalle@gmail.com

The institutional review board (IRB) approved this HIPAA-compliant study, and the need for patient informed consent was waived. Patients who had recently (within 2 weeks) undergone a Roux-en-Y gastric bypass or sleeve gastrectomy (Gastric Sleeve) referred to Arnot Ogden Medical Center radiology department for an upper gastrointestinal (UGI) series were included in this study. Patients were initially given 3% gastrografin (full-strength concentration). If negative, as per protocol, the upper-GI exam was repeated using thin barium (50% barium sulfate, 50% water). Only patients with an initial negative upper-GI series using gastrografin were included in this study. Patients under the age of 18 years old were excluded as well. Each patient functioned as their own control. The follow-up barium upper-GI exam acted as the experimental arm of the investigation. For eligible patients, the medical record data was extracted by the project authors and recorded as anonymized data which was used for statistical analysis.

Arnot Ogden Medical Center, Diagnostic Radiology Department, Elmira, NY

Derrick Wagoner D.O., Saad Farooq, MS-III, Joseph Ronsivalle, D.O.

EVALUATION OF POST-OPERATIVE LEAK WITH HIGH-DENSITY BARIUM AFTER NEGATIVE GASTROGRAFIN UPPER-GI SERIES

No extra-luminal leaks were demonstrated with the use of thin barium after an initial negative gastrografin exam. 57% of the participants so far have been post Gastric sleeve (4 cases) with 43% being post Roux-en-Y (3 cases).

PRELIMINARY RESULTS

Preliminary results demonstrate no additional benefit to performing a follow-up upper-GI exam using barium as the contrast agent. The small sample size limits the statistical power of the preliminary results. We intend to continue the project and submit for publication once sufficient data has been obtained.

Upper-GI Series: Fluoroscopic image of the gastrojejunal anastomosis in a patient post-op Roux-en-Y gastric bypass using Gastrografin (left image). Follow-up image of the same patient using barium (right image)

Upper-GI Series: Fluoroscopic image of the stomach in a patient post-op Roux-en-Y gastric bypass using Gastrografin (left image). Follow-up image of the same patient using barium (right image)

Roux-en-YGastricSleeve

Leak

No Leak