From the Journals

Imaging after bariatric surgery appears overdone


Key clinical point: No well-defined guidelines exist for when to use postoperative imaging in bariatric surgery patients.

Major finding: Approximately 70% of postoperative imaging findings were not symptom related, and incidental findings led to 71 additional studies.

Data source: A review of 578 patients who underwent gastric bypass or sleeve gastrectomy.

Disclosures: The researchers had no financial conflicts to disclose.



Nearly 70% of bariatric surgery patients received postoperative imaging, with more than one-third receiving CT imaging. This high level of screening resulted in symptom-related findings in only 23% of cases, and may be excessive, according to researchers who studied nearly 600 adults who underwent bariatric surgery.

“However, there is a lack of well-defined postoperative imaging guidelines,” they said. “Detrimental aspects of postoperative imaging include the potential for false-positive findings leading to further and often unnecessary investigations, radiation exposure, and additional cost,” they added.

ct scanner copyright picsfive/
To assess the value of postoperative imaging in bariatric surgery, the researchers reviewed data from 578 adults who underwent bariatric surgery at a single center between January 2008 and January 2013 (Surg Obes Relat Dis. 2017. doi: 10.1016/j.soard.2017.04.031).

The primary outcomes were the numbers of initial postimaging studies and whether the findings supported subsequent studies.

The study population included 399 adults who underwent laparoscopic bypass and 144 who underwent sleeve gastrectomy. The average age of the patients was 41 years and 90% were women.

The researchers identified 907 imaging studies performed in 400 patients (69% of the study population). Of these, 38% were ultrasound, 36% were CT, 15% were x-ray, 6.6% were fluoroscopy, 3.3% were MRI, and .6% were nuclear medicine.

On review of the imaging findings, the researchers found that half (50%) were unremarkable, while 13% were either surgery related or symptom related, 6.8% were not related to surgery but might have explained patients’ symptoms, 4.3% were surgery-related but not likely to explain symptoms, and 26% were incidental. “Interestingly, no incidental findings were found to be of major clinical importance; all were benign,” according to the researchers.

However, incidental findings led to a total of 71 additional studies, and to 5 laparoscopic cholecystectomies.

A univariate analysis showed that the factors with a significant impact a patient’s odds of undergoing postoperative abdominal imaging included having a bypass procedure vs. a sleeve procedure, older age, and lower baseline body mass index. In addition, patients with a history of abdominal surgery or dyspepsia or those who had a routine postoperative upper gastrointestinal series were significantly more likely to undergo CT scans. Patients with history of ulcer or reflux were significantly less likely to undergo CT scans.

Although the study was limited by the retrospective design and lack of information about possible imaging of patients at other centers, “results suggest that nonroutine postoperative abdominal imaging in the bariatric population is common and requires streamlined protocols, with almost 70% of patients undergoing imaging and greater than 70% of findings being unrelated to symptoms or negative,” the researchers said.

A clinical algorithm for imaging of bariatric patients should be based on clinical parameters collected during a physical exam. “Once an algorithm is in place, further studies will be needed to validate its accuracy and efficiency,” the researchers stated.

Dr. Haddad and her colleagues had no financial conflicts to disclose.

Next Article:

   Comments ()