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Imaging studies after bariatric surgery

Marina Kurian, MD
Section Editor
Daniel Jones, MD
Deputy Editor
Wenliang Chen, MD, PhD


Postoperative radiographic imaging studies following bariatric surgical procedures are typically obtained to identify the integrity and patency of anastomoses and to identify postoperative complications (eg, anastomotic leaks) precisely and early [1]. In addition, for patients who have had a gastric banding procedure, radiographic images allow for evaluation of band position and the size of the gastric pouch.

This topic review will present the normal and abnormal findings seen on radiologic evaluation after gastric banding, gastric bypass, sleeve gastrectomy, and biliopancreatic diversion. An overview of the various bariatric procedures and their complications and the role of endoscopic management of gastrointestinal complications of the most common bariatric surgical procedures are presented separately. (See "Bariatric operations for management of obesity: Indications and preoperative preparation" and "Late complications of bariatric surgical operations" and "Endoscopy in patients who have undergone bariatric surgery".)


There is no consensus as to whether imaging should be performed routinely, or selectively following bariatric surgery [2-4]. Before initiating a diet, most bariatric surgeons who obtain imaging following bariatric procedures that involve an anastomosis or stapling get an upper gastrointestinal series (UGI) series on postoperative day one. The advantage of this approach is that any leak, if present, can be addressed quickly. However, some surgeons only perform postoperative imaging selectively, based upon the patient's clinical progress [4-6].

A systematic review evaluated the sensitivity and specificity of UGI from data obtained from 19 studies involving 10,139 patients [7]. UGI had an overall sensitivity of 54 percent and a specificity of 100 percent for detecting anastomotic leak within two days of bariatric surgery. The threshold used to distinguish between positive and negative test results varied between institutions. Given the moderate sensitivity, the authors of this study suggested that treating marginal radiological evidence of leakage as presumptively positive maximizes the clinical utility of UGI. Although a majority of articles show that UGI series are better for identifying leak following bariatric surgery, a later study found better sensitivity and specificity with abdominal computed tomography (CT) compared with UGI (100 versus 95 percent) [8]. Irrespective of imaging modality chosen, any clinical suspicion of leak warrants investigation.

When bariatric surgery patients present with complaints of heartburn, nausea or vomiting, abdominal pain, or weight loss failure, imaging studies should be obtained to ensure prompt diagnosis of infection, obstruction, ischemia, or mechanical or technical failures of an operation [9,10]. Radiologic examination of severely obese patients can be technically difficult because of patient size, resulting in suboptimal imaging [11].

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Literature review current through: Nov 2017. | This topic last updated: Jul 18, 2017.
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