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

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.