Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2025; 17(7): 107092
Published online Jul 27, 2025. doi: 10.4240/wjgs.v17.i7.107092
Utility of routine postoperative upper gastrointestinal swallow studies following laparoscopic one anastomosis gastric bypass
Ata Maden, Amram Kupietzky, Yakira Zimand, Yehonatan Bar-Moshe, Roi Dover, Eyal Yonathan Juster, Moriya Drayer Lichtman, Ronit Grinbaum, Haggi Mazeh, Ido Mizrahi
Ata Maden, Amram Kupietzky, Roi Dover, Eyal Yonathan Juster, Moriya Drayer Lichtman, Ronit Grinbaum, Haggi Mazeh, Ido Mizrahi, Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9765422, Israel
Yakira Zimand, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
Yehonatan Bar-Moshe, Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9765422, Israel
Co-first authors: Ata Maden and Amram Kupietzky.
Author contributions: Maden A and Kupietzky A participated in the literature search, study design, data collection, data analysis, data interpretation, writing, and critical revision, and they are listed as co-first authors of this study; Zimand Y, Dover R, Drayer-Lichtman M, and Juster EY participated in the data collection, data analysis, data interpretation, writing, and critical revision; Bar-Moshe Y reviewed all the medical imaging, participated in data collection, and prepared all the figures; Grinbaum R and Mazeh H made substantial contributions to study design, data analysis, data interpretation, writing, and critical revision; Mizrahi I participated in the literature search, study design, data analysis, data interpretation, writing, and critical revision; All authors reviewed the manuscript.
Institutional review board statement: The study was reviewed and approved by the Hadassah Medical Center Institutional Review Board (Approval No. HMO-0656-21).
Informed consent statement: The need for informed consent was waived by our institutional review board, due to the retrospective nature of the study.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. There was no external funding for this manuscript.
STROBE statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amram Kupietzky, MD, Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Sderot Churchill, 8, Jerusalem 9765422, Israel. amramkupietzky@gmail.com
Received: March 16, 2025
Revised: April 16, 2025
Accepted: May 27, 2025
Published online: July 27, 2025
Processing time: 130 Days and 21 Hours
Abstract
BACKGROUND

Laparoscopic one anastomosis gastric bypass (OAGB) has grown in popularity in recent years for the treatment of morbid obesity. Despite routine practice, the utility of early postoperative upper gastrointestinal (UGI) swallow studies to detect complications following OAGB has been questioned.

AIM

To evaluate the effectiveness and cost-efficiency of performing routine UGI studies on the first postoperative day (POD) after OAGB.

METHODS

A retrospective cohort analysis of a prospectively collected database was conducted to identify all consecutive patients who underwent OAGB between January 2019 and July 2022. Patient demographics, operative data, and postoperative complication rates were analyzed. Reports from all imaging studies were retrospectively reviewed, and complications were recorded. The institutional review board waived the requirement for informed consent.

RESULTS

A total of 385 patients were included. All patients had an iodine-based contrast swallow study on the first POD. Abnormal findings were observed in 4 patients (1%), none of which were correlated with postoperative complications. Two patients (0.5%) required reoperation due to complications although both had normal UGI study results. Sensitivity and positive predictive value of UGI studies for detecting complications were 0%, while specificity and negative predictive value were 99% and 98%, respectively. Based on hospital charges the overall cost of all the UGI swallow studies performed in our study was 95865 USD.

CONCLUSION

The study findings showed that performing routine UGI swallow studies on the first POD after laparoscopic OAGB is ineffective in detecting complications and is not cost effective. Normal UGI studies might mislead clinicians in the postoperative period and thus should be omitted in favor of close clinical monitoring.

Keywords: Bariatric surgery; One anastomosis gastric bypass; Upper gastrointestinal swallow studies; Leak; Anastomotic leak

Core Tip: Routine upper gastrointestinal swallow studies on the first postoperative day after laparoscopic one anastomosis gastric bypass have long been used to detect complications. However, our study demonstrated that these studies have no diagnostic value, with 0% sensitivity for detecting leaks or other complications. Additionally, the high cost associated with routine upper gastrointestinal studies raises concerns about their cost-effectiveness. Given these findings, reliance on clinical monitoring rather than routine imaging may improve postoperative management while reducing unnecessary healthcare costs.