THE WORK-UP FOR BARIATRIC SURGERY DOES NOT REQUIRE A ROUTINE UPPER GASTROINTESTINAL SERIES

Background: Morbid obesity is a serious disease that afflicts over fiv e million Americans, threatening their health with such co-morbidities as diabetes, arthritis, pulmonary failure and stroke. Surgery is the only effective therapy, providing long-term control of weight, diabete s, pulmonary failure, and hypertension for as long as 14 years. Becaus e the operation presents a major expense, this study examined whether X-ray examination of the gut could be omitted safely as a cost-saving measure. Methods: The records of 814 consecutive morbidly obese patien ts who underwent gastric bypass were reviewed to determine: (1) whethe r these individuals had undergone an upper gastro-intestinal (GI) seri es, and (2) if these studies influenced therapy or caused cancellation or postponement of surgery. Results: Of the 814 patients, 657 (80.7%) underwent a preoperative GI radiography. Of these examinations, 393 ( 59.8%) were normal, with the following abnormalities in the remaining 264: hiatal hernia, 164; esophageal reflux, 39; Schatzki's ring, 18; s mall bowel diverticula, four; renal stones, four; malrotation, three; gall stones, two; pyloric ulcer, one; possible pelvic mass, one; calci fied leiomyoma, one; and dysphagial lusoria, one. None of these findin gs resulted in cancellation or a delay in surgery. Conclusions: The up per GI series can be safely omitted from the routine preoperative eval uation of patients undergoing gastric bypass. At a cost of $741.00 per examination, this change represents significant potential savings. Si milar evaluations of other routine preoperative tests may well provide a better basis for the evaluation of these complex patients.