Upper Endoscopy and Gastrointestinal Radiological Exams Results After Laparoscopic Adjustable Gastric Banding

Atul K Madan, MD FACS, Pejman Samouha, MD, Michael Omidi, MD, Julian Omidi. New Life Surgery Center, LLC

Introduction: Laparoscopic adjustable gastric banding (LAGB) is a useful procedure for the treatment of morbid obesity. While LAGB has a low morbidity and mortality, potential long-term issues can occur. Both upper endoscopy (Endo) and gastrointestinal radiological (Rad) exams may be helpful in diagnosing these potential issues after LAGB. This study investigated the role of Endo and Rad exams after LAGB.

Methods: A retrospective study of all Endo and Rad exams performed after LAGB over a 4-month period was performed. During this time, LAGB patients who presented with continual nausea/vomiting, new-onset reflux, port infection, and hematemesis underwent Endo and Rad exams. Almost all of the patients had LAGB performed by surgeons not involved in the study. All Endo and Rad exams were performed by a bariatric surgeon with experience in endoscopy. Results of the exams were complied.

Results: There were 50 patients included in this study. Most (90%) of the patients were women. The indications for Endo and Rad exams were port infection (2%), hematemesis (2%), nausea/vomiting (22%), reflux (66%), and nausea/vomiting with reflux (8%). The findings on Endo exam included duodenal ulcers (2%), erosion (2%), hiatal hernia (4%), enlarged pouch (6%), slippage (24%), and normal examination (62%). The findings on Rad exam were enlarged pouch (2%), tight band (4%), erosion (4%), hiatal hernia (4%), slippage (34%), and normal examination (52%). Two (4%) patients had positive findings only noted on Endo and 6 (12%) patients had positive findings only on Rad. Most (62%) patients had a positive finding on either Endo or Rad exam.

Conclusions: Patients who have issues after LAGB should be investigated with both Endo and Rad exams. Both exams together are high yield in diagnosing issues after LAGB. Continual nausea/vomiting, new onset reflux, port infection, and hematemesis after LAGB should all alert bariatric surgeons for potential issues. Bariatric surgeons should consider performing their own endoscopy and radiology exams to better diagnose issues after LAGB.