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OGD more reliable in identifying complications

OGD should be the first line investigation to investigate for post bariatric surgery dysphagia, vomiting or dyspepsia

Oesophagogastroduodenoscopy (OGD) is more reliable in identifying post-operative complications following a bariatric operation compared to a watersoluble contrast swallow, according to researchers from Walsall Manor Hospital, Walsall, UK.

“Symptoms of dysphagia and dyspepsia are common following a bariatric operation,” said study presenter, Dr Prashant Patel. “Current practice reveals a variation between a water-soluble contrast swallow and oesophagogastroduodenoscopy (OGD) as a first line investigation to assess for complications. Our aim was to identify and compare the clinical effectiveness of both.”

Prashant Patel

They conducted a retrospective study on 146 patients between 2008-2012. Patients who had >1 OGD to investigate a post-operative complication were included for analysis. Patient demographics, OGD, water-soluble contrast and additional interventions reports were collated from electronic records, pathology and radiology results.

From the 146 patients who presented with a post-operative complication following a bariatric operation 111 (76%) had an open gastric bypass, one (0.5%) had a laparoscopic gastric bypass, 13 (9%) had gastric bands and 21 (14%) had a laparoscopic sleeve gastrectomy.

Dysphagia (+/-) vomiting was the main postoperative complaint seen in 108 (74%) patients. In addition, patients also presented with dyspepsia, port site infection and abdominal pain. Ninety two (63%) OGD(s) found a significant pathology, including 57 (39%) strictures all following an open gastric bypass, gastritis (n=14, 10%) and gastric ulcers (n=9, 6%).

Eighty two (56%) patients had a water-soluble contrast swallow prior to the OGD, of which only 13 (16%) found a significant pathology, the most significant including narrowing (n=3, 3.6%) and stricture (n=1, 1%). A large (n=45, 65%) proportion of reported ‘normal’ water-soluble contrast swallow had a significant pathology on an OGD.

In total, there were 54 (66%) pathologies reported following an OGD that was not reported on a water-soluble contrast swallow, the most significant including strictures (n=28, 52%), gastritis (n=10, 19%), gastric ulcers (n=6, 11%) and hiatus hernia (n=2, 4%).

“These results demonstrate that an OGD is more reliable in identifying post-operative complications following a bariatric operation compared to a watersoluble contrast swallow,” concluded Patel.  “A vast number of pathologies, 66%, were missed on a water-soluble contrast that was identified on an OGD, in particular strictures. We recommend that an OGD should be the first line investigation to investigate for post bariatric surgery dysphagia, vomiting or dyspepsia.”

Co-authors of the study were Amit Rajput, Anna Elshaw, frances Young, Sarah Dalrymple, Salman Mirza and Amir Khan.

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