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Invited Critique
October 1, 2007

Routine Postoperative Upper Gastrointestinal Series After Roux-en-Y Gastric Bypass: Determination of Whether It Is Necessary—Invited Critique

Arch Surg. 2007;142(10):934. doi:10.1001/archsurg.142.10.934

Upper gastrointestinal series (UGI) after gastric bypass has been assumed by some surgeons to be a reliable enough study that all postoperative patients should undergo it before leaving the hospital. They also hold on to the belief that the study is worth doing on all patients even if it will pick up just 1 leak that they did not suspect because a leak is 1 of the top 2 causes of mortality after gastric bypass surgery. The article by Kolakowski et al brings to light that this test fails to find leaks that were not already suspected by clinical findings. In fact, all patients with a leak had clinical symptoms in this series. A combination of sustained tachycardia (pulse rate, >120 beats/min), respiratory distress, and fever was seen in 7 of the 8 patients who had a leak. Only 1 patient without a leak had all 3 symptoms. The authors believe that 4 of the 12 leaks seen on UGI were false-positive results because the patients did not progress to show clinical signs of a leak after an additional 48 hours of observation. Similar findings were seen in a retrospective study of UGI after gastric bypass by Singh and Fisher.1 All patients in this series with a clinically significant leak had clinical signs to warrant further investigation. This led to their conclusion that only selective UGI was necessary based on clinical findings, and that it would lead to annual US cost savings of 5 million health care dollars.1

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