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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. World Health Organization. Obesity and overweight.  Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Review/Other-Dx N/A To provide key facts from WHO on obesity and overweight. No abstract available 4
2. Centers for Disease Control and Prevention. Adult Obesity Facts.  Available at: https://www.cdc.gov/obesity/data/adult.html. Review/Other-Dx N/A To provide facts through CDC on adult obesity. No abstract available 4
3. Kawai T, Autieri MV, Scalia R. Adipose tissue inflammation and metabolic dysfunction in obesity. Am J Physiol Cell Physiol 2021;320:C375-C91. Review/Other-Dx N/A To broadly present an overview of adipose tissue inflammation by highlighting the most recent reports in the scientific literature and summarizing our overall understanding of the field.To discuss key endogenous anti-inflammatory mediators and analyze their mechanistic role(s) in the pathogenesis and treatment of adipose tissue inflammation. No results in abstract. 4
4. Mechanick JI, Apovian C, Brethauer S, et al. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists - Executive Summary. Endocr Pract 2019;25:1346-59. Review/Other-Dx N/A To identify patient candidates for bariatric procedures, discusses which types of bariatric procedures should be offered, outlines management of patients before procedures, and recommends how to optimize patient care during and after procedures. To assist health-care professionals achieve greater precision in clinical decision-making and discusses the importance of a team approach to patient care, with special attention on nutrition, metabolism, and interventions to improve recovery after bariatric surgery. No results in abstract. 4
5. Clayton RD, Carucci LR. Imaging following bariatric surgery: roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and sleeve gastrectomy. [Review]. British Journal of Radiology. 91(1089):20180031, 2018 Sep. Review/Other-Dx N/A To provide an overview of the potential complications is provided in addition to a description of potential pitfalls in interpreting these studies. No results in abstract. 4
6. De Simone B, Ansaloni L, Sartelli M, et al. The Operative management in Bariatric Acute abdomen (OBA) Survey: long-term complications of bariatric surgery and the emergency surgeon's point of view. World Journal Of Emergency Surgery. 15(1):2, 2020 01 06. Review/Other-Dx 117 international emergency surgeons (ES) To investigate by a web survey how an emergency surgeon approaches this unique group of patients in an emergency medical scenario and to report their personal experience. One hundred seventeen international emergency surgeons decided to join the project and answered to the web survey with a response rate of 59.39%. 4
7. Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis 2022;18:1345-56. Review/Other-Dx N/A To provide current available scientific information on metabolic and bariatric surgery and its indications. No results in abstract. 4
8. International Federation for Surgery for Obesity and Metabolic Disorders. IFSO 8TH GLOBAL REGISTRY REPORT.  Available at: https://www.ifso.com/pdf/8th-ifso-registry-report-2023.pdf. Review/Other-Dx N/A To aspire to provide the most credible and transparent information available on metabolic bariatric surgery.To achieve this mission we aim to provide descriptive data about caseload / penetrance of surgery for metabolic disease and obesity in various countries as well as aspire to provide real-world post approval surveillance of procedures / devices. No abstract available 4
9. American Society for Metabolic and Bariatric Surgery. Obesity in America.  Available at: https://asmbs.org/resources/obesity-in-america/. Review/Other-Dx N/A To provide facts through American Society for Metabolic and Bariatric Surgery on obesity in America. No abstract available 4
10. Lesourd R, Greilsamer T, de Montrichard M, et al. Lack of benefit of routine abdominal CT-scan before bariatric surgery. Journal of visceral surgery. 158(5):390-394, 2021 10.J Visc Surg. 158(5):390-394, 2021 10. Review/Other-Dx 521 patients To study performance of abdominal CT-scan before bariatric surgery. We included 521 patients (417 women and 104 men) with a mean age of 48.0±11.5 years. Mean preoperative body mass index was 44.9±7.0kg/m2. Among the 392 patients with abnormal CT-scan, mean number of anomalies per patient was of 2.2±1.2. Vast majority of anomalies (91.8%) were non-significant. Only 5 (1%) patients needed treatment prior to bariatric surgery. No factor predictive of abnormal CT-scan was found. 4
11. Schneider R, Lazaridis I, Kraljevic M, Beglinger C, Wolnerhanssen B, Peterli R. The impact of preoperative investigations on the management of bariatric patients; results of a cohort of more than 1200 cases. Surg Obes Relat Dis 2018;14:693-99. Review/Other-Dx 1225 consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass (n = 834) or sleeve gastrectomy (n = 391) To identify the pathologies of the endoscopic and radiologic investigations before performing bariatric surgery and to evaluate their impact on the patient management. Gallstones were detected in 222 (21.0%) patients, and a synchronous cholecystectomy was performed in 220 (18.0%) patients. The upper GI series indicated hiatal hernias in 325 (27.6%) patients. The most common findings of the upper GI endoscopy were type-C gastritis (224 patients, 18.8%), reflux esophagitis (229 patients, 19.2%), Helicobacter pylori-positive gastritis (158, 13.3%), and hiatal hernia (55 patients, 4.6%). Additionally, we detected 1 Barrett's high-grade dysplasia, 2 Barrett's carcinomas, and 1 stomach cancer in asymptomatic patients, who were scheduled to have a sleeve gastrectomy. Esophageal motility disorders were detected in 104 (17.0%) individuals, who underwent esophageal manometry. 4
12. Sharaf RN, Weinshel EH, Bini EJ, Rosenberg J, Ren CJ. Radiologic assessment of the upper gastrointestinal tract: does it play an important preoperative role in bariatric surgery? Obes Surg 2004;14:313-7. Review/Other-Dx 171 patients that underwent UGIS prior to bariatric surgery To evaluate the diagnostic yield and cost of routine UGIS prior to bariatric surgery During the 18-month study period, 171 patients were evaluated by UGIS prior to bariatric surgery. One or more lesions were identified in 48.0% of patients, with only 5.3% having clinically important findings. The prevalence of radiologic findings using the classification system above was as follows: group 0 (52.0%), group 1 (42.7%), group 2 (5.3%), and group 3 (0.0%). The most common findings identified were esophageal reflux (21.6%) and hiatal hernias (18.7%). The cost of performing routine UGIS on all patients before bariatric surgery was 2,941.20 USD per clinically important finding detected. 4
13. Abou Hussein BM, Khammas A, Makki M, et al. Role of Routine Abdominal Ultrasound Before Bariatric Surgery: Review of 937 Patients. Obesity Surgery. 28(9):2696-2699, 2018 09. Review/Other-Dx 1,120 medical records of patients with abdominal ultrasound To investigate whether routine abdominal ultrasound prior to bariatric surgery affects the surgical plan or not. One thousand one hundred twenty files were reviewed. Results were missing in 183 files, thus excluded; remaining 937 files were included. Mean age of patients was 37 ± 12 years, 589 (63%) were females and 348 (37%) were males. Mean BMI was 45.1 ± 9.8 kg/m2. Ultrasound was normal in 354 (37.7%) of patients and abnormal in 583 (62.3%). 4
14. Almazeedi S, Al-Sabah S, Alshammari D. Routine trans-abdominal ultrasonography before laparoscopic sleeve gastrectomy: the findings. Obes Surg. 24(3):397-9, 2014 Mar. Observational-Dx 747 patients undergoing LSG were screened pre-operatively with transabdominal ultrasonography To observe the prevalent findings on routine pre-operative transabdominal ultrasonography when used as a screening tool prior to laparoscopic sleeve gastrectomy (LSG). Five hundred ninety (79.0 %) patients were females while 157 (21.0 %) were males, with an overall median body mass index (BMI) of 45 (30-90). Two hundred forty patients (32.1 %) had normal pre-operative ultrasonography results, 83 (11.1 %) were found to have gallstones, 427 (57.2 %) had fatty liver, and 55 (7.4 %) had other pathologies. There was no statistically significant association between BMI and gallstones (p = 0.545) and BMI and fatty liver (p = 0.418). Trans-abdominal ultrasonography screening prior to LSG revealed a wide range of findings but does not add significant information to the pre-operative workup of patients undergoing the procedure and should be reserved for indicated patients. 4
15. Diaz Vico T, Elli EF. Utility of Immediate Postoperative Upper Gastrointestinal Contrast Study in Bariatric Surgery. Obesity Surgery. 29(4):1130-1133, 2019 04. Review/Other-Dx 284 patients (197 patients underwent RYGB, while 87 underwent SG) To determine the usefulness of routine UGI contrast studies during postoperative day (POD) 1 in patients who underwent bariatric surgery. A total of 284 patients were analyzed; 197 (69.4%) patients underwent RYGB, while 87 (30.6%) underwent SG. Routine UGI contrast study was performed in 96 (48.7%) patients in the RYGB group versus 31 (35.6%) in the SG group. The overall adverse effect rate was 2 (0.7%); postoperative UGI contrast study was negative in both cases. Mean (SD) length of stay (LOS) for patients who underwent UGI contrast study versus those who did not was similar in the RYGB group (1.8 [1.6] days vs 1.8 [0.9] days, respectively) and the SG group (2 [1.18] days vs 1.9 [0.9] days). The average cost of a postoperative UGI contrast study was $600, resulting in an additional overall cost of $76,800. 4
16. Kim J, Azagury D, Eisenberg D, et al. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis 2015;11:739-48. Review/Other-Dx N/A To provide objective information about the complication of leak regarding reasonable approaches to the prevention and postoperative detection based on current knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. No results in abstract 4
17. Lainas P, Triantafyllou E, Chague P, et al. Routine Early Computed Tomography Scanner After Laparoscopic Sleeve Gastrectomy in High-Risk Severely Obese Patients Is Effective for Bleeding or Hematoma Diagnosis but not for Staple-Line Leak Detection: a Prospective Study. Obesity Surgery. 32(5):1624-1630, 2022 05. Observational-Dx 1,051 high-risk patients To prospectively assess the interest of systematic early CT scan after LSG in high-risk severely obese patients based on well-known morbidity risk factors. Early postoperative surgical complications occurred in 48 patients (4.5%): 25 (2.3%) intraabdominal hemorrhage and 23 (2.2%) staple-line leak. Early CT-scanner detected intraabdominal bleeding or hematoma in 22/25 patients, with 95.6% sensitivity (Youden's index = 0.95), while specificity was 100%, positive predictive value (PPV) 100%, and negative predictive value (NPV) 99.9%. Sensitivity of early postoperative CT-scanner was 43.4% (10/23 patients; Youden's index = 0.43) for staple-line leak detection, with specificity of 100%, PPV 100%, and NPV 98.7%. 3
18. Mbadiwe T, Prevatt E, Duerinckx A, Cornwell E 3rd, Fullum T, Davis B. Assessing the value of routine upper gastrointestinal contrast studies following bariatric surgery: a systematic review and meta-analysis. [Review]. American Journal of Surgery. 209(4):616-22, 2015 Apr. Review/Other-Dx 19 studies (10,139 patients) To determine the sensitivity and specificity of UGI conducted routinely within 2 days after bariatric surgery for detecting anastomotic leaks. GI has an overall sensitivity of .54 and a specificity of 1.00. The standard deviation of the reported sensitivities was .36. Positive and negative predictive values were .67 and .98, respectively. Sensitivity and specificity were negatively correlated. 4
19. Mittermair R, Sucher R, Perathoner A, Wykypiel H. Routine upper gastrointestinal swallow studies after laparoscopic sleeve gastrectomy are unnecessary. American Journal of Surgery. 207(6):897-901, 2014 Jun. Review/Other-Dx 161 patients who underwent laparoscopic sleeve gastrectomy To evaluate the usefulness of early upper gastrointestinal (UGI) contrast studies in the detection of postoperative complications. Among the 161 patients who underwent UGI, no contrast leaks were found on POD 1. Three patients (1.9%) developed stapler line leaks near the gastroesophageal junction, which were diagnosed on PODs 3, 4, and 10. Gastroesophageal reflux in 5 patients (3.1%) and delayed gastroesophageal transit in 10 patients (6.2%) were detected. 4
20. Quartararo G, Facchiano E, Scaringi S, Liscia G, Lucchese M. Upper gastrointestinal series after Roux-en-Y gastric bypass for morbid obesity: effectiveness in leakage detection. a systematic review of the literature. [Review]. Obesity Surgery. 24(7):1096-101, 2014 Jul. Review/Other-Dx 22 studies To evaluate the results of routine and selective postoperative upper gastrointestinal series (UGIS) after Roux-en-Y gastric bypass (RYGB) for morbid obesity in different published series to assessing its utility and cost-effectiveness. A search in PubMed's MEDLINE was performed for English-spoken articles published from January 2002 to December 2012. Keywords used were upper GI series, RYGB, and obesity. Only cases of anastomotic leaks were considered. A total of 22 studies have been evaluated, 15 recommended a selective use of postoperative UGIS. No differences in leakage detection or in clinical benefit between routine and selective approaches were found. Tachycardia and respiratory distress represent the best criteria to perform UGIS for early diagnosis of anastomotic leak after a RYGB. 4
21. Lainas P, Tranchart H, Gaillard M, Ferretti S, Donatelli G, Dagher I. Prospective evaluation of routine early computed tomography scanner in laparoscopic sleeve gastrectomy. Surgery for Obesity & Related Diseases. 12(8):1483-1490, 2016 Sep - Oct. Observational-Dx 1000 patients undergoing single-incision LSG and POD 2 CT scan To prospectively assess the impact of postoperative day (POD) 2 CT scan after laparoscopic sleeve gastrectomy (LSG). Mean age was 40.1 years and median BMI 42.6 kg/m². Early postoperative surgical complications occurred in 66 patients (6.6%). Intraabdominal bleeding/hematoma occurred in 38 patients, with 3 requiring emergent reoperation on POD 1. POD 2 CT scan detected this complication in 32 patients (sensitivity: 91.4%). Twenty-four (63.1%) patients were treated with relaparoscopy and drainage while 14 (36.9%) received conservative management. Postoperative transfusion was required in 7 patients. Twenty-eight patients suffered a gastric staple line leak, 13 (sensitivity: 46.4%) detected on POD 2 CT scan. Three patients (10.7%) received pure surgical treatment, 16 (57.1%) combined relaparoscopy and endoscopic treatment, and 9 (32.2%) had pure endoscopic treatment. 3
22. Wahby M, Salama AF, Elezaby AF, et al. Is routine postoperative gastrografin study needed after laparoscopic sleeve gastrectomy? Experience of 712 cases. Obesity Surgery. 23(11):1711-7, 2013 Nov. Review/Other-Dx 712 cases that underwent LSG To evaluate the usefulness of the current standard of care, which is to perform a postoperative gastrografin study following laparoscopic sleeve gastrectomy (LSG) to detect leakage or obstruction Patients included in this study were 556 women (78.1%) and 156 men (21.9%). The mean age was 35 years. The mean BMI was 48 kg/m2. The operative time was 107 ± 29 min, and there were no conversions to open surgery. Intraoperative methylene blue test detected leakage in 28 cases (3.93%). Postoperative contrast study (gastrografin) was negative for leakage in all cases. Computed tomography (CT) scan with oral contrast study detected leakage in 1.4% (ten cases); none of these cases were detected by regular contrast study. 4
23. Gnecchi M, Bella G, Pino AR, et al. Usefulness of x-ray in the detection of complications and side effects after laparoscopic sleeve gastrectomy. Obesity Surgery. 23(4):456-9, 2013 Apr. Review/Other-Dx 101 consecutive patients underwent LSG for morbid obesity To assess the usefulness of early x-ray examination and subsequent x-ray follow-up in the detection of postoperative complications and long-term functional recovery. Early postoperative x-ray examination detected one case of suture leakage 1 day after surgery as well as one abscess and one gastric fistula in two patients who had become symptomatic 9 and 10 days after surgery. 4
24. Burt JR, Kocher MR, Snider L, et al. Computed Tomography Assessment of Gastric Band Slippage. Visc Med 2022;38:288-94. Observational-Dx 67 patients evaluated for gastric band slippage using CT To develop and validate reliable computed tomography (CT) imaging criteria for the diagnosis of gastric band slippage. There was good overall interobserver agreement for diagnosis of gastric band slippage using CT diagnostic criteria (kappa = 0.83). Agreement was excellent for the "O" sign (kappa = 0.93) and phi angle (intraclass correlation coefficient = 0.976). The "O" sign, inferior displacement from the hiatus >3.5 cm, and gastric pouch volume >55 cm3 each had 100% positive predictive value. A phi angle <20° or >60° had the highest negative predictive value (NPV) (98%). Of all CT diagnostic criteria, enlarged gastric pouch size was most correlated with band slippage with an AUC of 0.991. 2
25. Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy and postoperative complications. [Review]. Radiology. 270(2):327-41, 2014 Feb. Review/Other-Dx N/A To present the surgical anatomy and normal imaging findings and postoperative complications for these bariatric procedures at fluoroscopic examinations and CT. No results in abstract. 4
26. Lall C, Cruz AA, Bura V, Rudd AA, Bosemani T, Chang KJ. What the radiologist needs to know about gastrointestinal endoscopic surgical procedures. [Review]. Abdominal Radiology. 43(6):1482-1493, 2018 06. Review/Other-Dx N/A To inform radiologists how gastrointestinal endoscopic surgical procedures are performed, as well as expected post-procedural imaging appearance and potential complications. No results in abstract. 4
27. Swenson DW, Pietryga JA, Grand DJ, Chang KJ, Murphy BL, Egglin TK. Gastric band slippage: a case-controlled study comparing new and old radiographic signs of this important surgical complication. AJR Am J Roentgenol 2014;203:10-6. Observational-Dx 21 patients with a surgically proven slipped gastric band; 63 randomly-selected asymptomatic gastric band patients who had undergone barium swallow To compare the diagnostic performance of four radiographic signs of gastric band slippage: abnormal phi angle, the "O sign," inferior displacement of the superolateral gastric band margin, and presence of an air-fluid level above the gastric band. In evaluating for gastric band slippage, an abnormal phi angle greater than 58° was 91-95% sensitive and 52-62% specific (? = 0.78), the O sign was 33-48% sensitive but 97% specific (? = 0.84), inferior displacement of the superolateral band margin by more than 2.4 cm from the diaphragm was 95% sensitive and 97-98% specific (? = 0.97), and the presence of an air-fluid level was 95% sensitive and 100% specific (? = 1.00). 2
28. Francica G, Giardiello C, Scarano F, Cristiano S, Iodice G, Delle Cave M. Ultrasound diagnosis of intragastric balloon complications in obese patients. Radiologia Medica. 108(4):380-4, 2004 Oct.Radiol Med (Torino). 108(4):380-4, 2004 Oct. Review/Other-Dx 151 BIBs To describe ultrasonography (US) aspects of complications related to the use of the Bioenterics intragastric balloon (BIB) system for the treatment of moderate obesity. The BIB appeared as a round anechoic structure, with a thick hyperechoic wall and a hyperechoic band-like valve inside. In 8 cases staining of urine and/or faeces prompted immediate endoscopic removal. In 10 patients US findings of BIB-related complications were: 1) decreased volume with a visible valve (5 cases; in two of these staining of urine was reported); 2) multiple hyperechoic streaks regularly spaced due to a completely collapsed BIB, not modified by decubitus changes (3 cases; one patient reported staining of urine); 3) migration through the bowel (2 cases): in one patient the BIB was passed after 4 days, whereas in the other case bowel obstruction required laparoscopic surgery. 4
29. Haddad D, David A, Abdel-Dayem H, Socci N, Ahmed L, Gilet A. Abdominal imaging post bariatric surgery: predictors, usage and utility. Surgery for Obesity & Related Diseases. 13(8):1327-1336, 2017 Aug. Observational-Dx 578 patients (399 gastric bypass, 179 sleeve gastrectomy) To investigate our institutional usage and utility of nonroutine postoperative abdominal imaging. A total of 578 patients were included (399 gastric bypass, 179 sleeve gastrectomy); 907 nonroutine studies in 69% of patients were performed, and 36% patients underwent computed tomography (CT). Only 20.3% of findings were symptom-related, 26% had benign incidental findings, and 50% were negative. Incidental findings prompted 71 additional studies. Bypass procedure (sleeve versus bypass, odds ratio [OR] .3), older age (median 43 versus 48 years), and lower initial body mass index (BMI) (median 43 versus 45) increased the likelihood of imaging. History of prior abdominal surgery and dyspepsia increased the probability of undergoing CT by an odds ratio of 1.8 and 2.0, respectively (P<.05). History of ulcer (OR .6) or reflux on routine upper gastrointestinal imaging (OR .3) decreased probability (P<.05). Patients who underwent CT were more likely to undergo other abdominal imaging (3 versus 1 study per patient, P<.01). 4
30. Morandeira C, Barcena MV, Bilbao A, et al. Studying the complications of bariatric surgery with intravenous contrast-enhanced multidetector computed tomography. Radiologia. 60(2):143-151, 2018 Mar - Apr. Review/Other-Dx 155 patients who underwent gastric bypass or sleeve gastrectomy To review the complications of bariatric surgery and their diagnosis with intravenous contrast-enhanced multidetector computed tomography (MDCT). We reviewed 155 cases and found 24 complications in 22 patients: 16 early complications (7 intraperitoneal hematomas, 5 anastomotic dehiscences, 2 intestinal obstructions, and 2 external hernias) and 8 late complications (3 internal hernias, 3 intestinal perforations, and 2 marginal ulcers). Two patients died. All of these complications were diagnosed with intravenous contrast-enhanced MDCT, except one, which required a barium transit study. 4
31. Dupree A, de Heer J, Tichby M, et al. The value of CT imaging and CRP quotient for detection of postbariatric complications. Langenbecks Archives of Surgery. 406(1):181-187, 2021 Feb. Observational-Dx 587 patients who underwent operations (primary or revisional) in a 3-year period To show the relevance of routinely assessed clinical and paraclinical parameters as well as the relevance of CT scans in the diagnosis of major complications after bariatric procedures. A total of 587 patients were examined. In this cohort, 73 CT scans were performed due to suspected intraabdominal or pulmonary complication according to our hospital standard operating procedure. In total, 14 patients (2.4%) had a major complication (Clavien-Dindo grade IV/V). Of those, 10 patients (1.7%) had postoperative leakage. While the correct leakage diagnosis was only found in 33% of the patients by CT scan, the overall specificity of CT as a diagnostic tool for all kinds of complications remained high. Especially for abscess detection, CT scan showed a sensitivity and specificity of 100%. Multivariate analysis showed a significantly higher risk of leakage development characterized by a doubling of postoperative CRP level (odds ratio 4.84 (95% confidence interval 2.01-11.66, p < 0.001)). To simplify the use of CRP as a predictive factor for the diagnosis of leakage, a cut-off value of 2.4 was determined for the CRP quotient (POD3/POD1) with a sensitivity of 0.88 and a specificity of 0.89. 4
32. Bingham J, Shawhan R, Parker R, Wigboldy J, Sohn V. Computed tomography scan versus upper gastrointestinal fluoroscopy for diagnosis of staple line leak following bariatric surgery. American Journal of Surgery. 209(5):810-4; discussion 814, 2015 May. Observational-Dx 629 tests To independently determine the sensitivity and specificity of UGI with CT scan in the evaluation of staple line leak following bariatric surgery. Six hundred nineteen radiographic "leak tests" were selectively performed following bariatric procedures at our institution between January 2005 and December 2011. CT was found to have a sensitivity of 95% (95% confidence interval [CI] 81.8 to 99.1) and a specificity of 100% (95% CI 93.1 to 100) in diagnosing postoperative leaks, while UGI demonstrated a sensitivity of 79.4% (95% CI 61.6 to 90.0) and a specificity of 95% (95% CI 85.2 to 98.7). 2
33. Musella M, Cantoni V, Green R, et al. Efficacy of Postoperative Upper Gastrointestinal Series (UGI) and Computed Tomography (CT) Scan in Bariatric Surgery: a Meta-analysis on 7516 Patients. Obesity Surgery. 28(8):2396-2405, 2018 08. Meta-analysis 18 articles including 7516 patients To demonstrate the lack of utility and efficacy of routine early postoperative upper gastrointestinal study (UGI) in obese patients undergoing bariatric surgery and to show the higher efficacy of CT scan in cases of clinical suspicion of a leakage, a meta-analysis was performed. Starting from 1233 eligible citations, 18 articles, including 7516 patients, were left. The pooled sensitivity was 54% for UGI (95% CI 34-74) with a high heterogeneity (I2 = 99.8%, p < .001), whereas CT scan showed a pooled sensitivity of 91% (95% CI 89-93) significantly higher than sensitivity of UGI series (p < 0.01), with a high heterogeneity (I2 = 98.9%, p < .001). In symptomatic patients the pooled sensitivity of UGI series was significantly lower than sensitivity of CT scan [49% (95% CI 31-68) vs 94% (95% CI 92-96), p < 0.01]. PPV showed a significant difference between UGI series and CT scan (54 vs 100%, p < 0.01). Specificity for UGI series was 98.6%, and specificity for CT scan was 99.7% (p = ns); the mean NPV was 96 and 98% for UGI series and CT scan (p = ns). Not Assessed
34. Dilauro M, McInnes MD, Schieda N, et al. Internal Hernia after Laparoscopic Roux-en-Y Gastric Bypass: Optimal CT Signs for Diagnosis and Clinical Decision Making. Radiology. 282(3):752-760, 2017 03. Observational-Dx 154 patients who had undergone laparoscopic Roux-en-Y gastric bypass with surgically confirmed IH (n = 76) and without IH (n = 78) To evaluate the accuracy of computed tomography (CT) for diagnosis of internal hernia (IH) in patients who have undergone laparoscopic Roux-en-Y gastric bypass and to develop decision tree models to optimize diagnostic accuracy. Accuracy and interobserver agreement regarding the nine CT signs of IH showed considerable variation. The best signs were mesenteric swirl (sensitivity and specificity, 86%-89% and 86%-90%, respectively; ? = 0.74) and SMV beaking (sensitivity and specificity, 80%-88% and 94%-95%, respectively; ? = 0.83). Overall reader impression yielded the highest sensitivity and specificity (96%-99% and 90%-99%, respectively; ? = 0.79). The decision tree model with the highest overall accuracy and sensitivity included mesenteric swirl and SBO, with a diagnostic odds ratio of 154 (95% confidence interval [CI]: 146, 161), sensitivity of 96% (95% CI: 87%, 99%), and specificity of 87% (95% CI: 75%, 93%). The decision tree with the highest specificity included SMV beaking and SBO, with a diagnostic odds ratio of 105 (95% CI: 101, 109), sensitivity of 90% (95% CI: 79%, 95%), and specificity of 92% (95% CI: 83%, 97%). 3
35. Goudsmedt F, Deylgat B, Coenegrachts K, Van De Moortele K, Dillemans B. Internal hernia after laparoscopic Roux-en-Y gastric bypass: a correlation between radiological and operative findings. Obesity Surgery. 25(4):622-7, 2015 Apr. Observational-Dx 7,328 patients underwent a LRYGB To evaluate the sensitivity and specificity of ten different CT findings in patients with a proven internal hernia after a laparoscopic Roux-en-Y gastric bypass (LRYGB). Between 2004 and 2013, 7,328 patients underwent a LRYGB. One hundred sixty nine of these patients underwent an explorative laparoscopy for abdominal pain after a LRYGB, 131 of which had a preoperative CT scan. Of these 131 patients, 72 suffered from an IH. Fifty-nine patients had no IH and served as control group. Mesenteric swirl was the best predictor with for reader 1 a sensitivity of 68% and specificity of 86% and for reader 2 a sensitivity of 89% and specificity of 63%. Other signs had an even larger interobserver variability. 3
36. Altieri MS, Pryor AD, Telem DA, Hall K, Brathwaite C, Zawin M. Algorithmic approach to utilization of CT scans for detection of internal hernia in the gastric bypass patient. Surgery for Obesity & Related Diseases. 11(6):1207-11, 2015 Nov-Dec. Observational-Dx 52 patients who underwent an operation for a suspected internal hernia (IH) To review our institutional experience and create an algorithm to approach patients presenting with abdominal pain and/or emesis after certain bariatric procedures. Of the 50 patients, 25 (50%) had IH at operation. Twenty-nine patients (58%) had positive CT scans read for IH and/or obstruction. Of these 29, 19 (66%) were found to have IH at operation and 10 (34%) underwent negative diagnostic laparoscopy. Of the 21 patients with negative CT scans, 6 (29%) had IH at operation versus 15 (71%) who were negative. The sensitivity of CT scan to detect an internal hernia is 76% with 95% confidence interval (CI) [53% to 90%] and specificity is 60% with 95% CI [39% to 78%]. Sensitivity increased to 96% with 95% CI [78% to 99.8%] when combining CT scans with neutrophilia findings. 3
37. Frokjaer JB, Jensen WN, Holt G, Omar HK, Olesen SS. The diagnostic performance and interrater agreement of seven CT findings in the diagnosis of internal hernia after gastric bypass operation. Abdominal Radiology. 43(12):3220-3226, 2018 12. Observational-Dx 117 patients (40 in internal herniation group; 77 in control group) To evaluate the interrater agreement and diagnostic performance characteristics of seven predefined CT findings of internal herniation in patients admitted on clinical suspicion of internal herniation after laparoscopic Roux-en-Y gastric bypass (LRYGB). The highest interrater agreements were seen for the swirl sign, SMV strangulation, ascites, and overall conclusion (all Kappa 0.82-0.83). The presence of internal hernia was significantly and independently associated with SMV strangulation (OR 18.3; 95% CI 4.3-78.1; p < 0.001) and mesenteric edema (OR 5.2; 95% CI 1.4-19.6; p < 0.001) on multivariate analysis, while the other CT findings were not independently associated with herniation. The highest sensitivity was observed for mesenteric edema (85.0%), while SMV strangulation had the highest specificity (94.8%). 3
38. Ederveen JC, Nienhuijs SW, Jol S, Robben SGF, Nederend J. Structured CT reporting improves accuracy in diagnosing internal herniation after laparoscopic Roux-en-Y gastric bypass. European Radiology. 30(6):3448-3454, 2020 Jun. Observational-Dx 174 CT scans with structured reporting and 289 CT scans without structured reporting To confirm that structured reporting of CT scans using ten signs in clinical practice leads to a better accuracy in diagnosing internal herniation (IH) after gastric bypass surgery, compared with free-text reporting. Sensitivity was 81.3% (95% CI, 67.7-94.8%) and 79.5% (95% CI, 67.6-91.5%), respectively (p = 0.854); specificity was 95.8% (95% CI, 92.5-99.1%) and 88.6% (95% CI, 84.6-92.6%), respectively (p = 0.016); PPV was 81.3% (95% CI, 67.7-94.8%) and 55.6% (95% CI, 43.3-67.8%), respectively (p = 0.014); NPV was 95.8% (95% CI, 92.5-99.1%) and 96.0% (95% CI, 93.5-98.6%), respectively (p = 0.909); and accuracy was 93.1% (95% CI, 88.0-96.2%) and 87.2% (95% CI, 82.7-90.7%), respectively (p = 0.045). 1
39. Zaigham H, Ekelund M, Lee D, Ekberg O, Regner S. Intussusception After Roux-en-Y Gastric Bypass: Correlation Between Radiological and Operative Findings. Obesity Surgery. 33(2):475-481, 2023 02. Observational-Dx 35 Roux-en-Y gastric bypass (RYGB) patients with acute abdominal CT scans reporting intussusceptions To correlate radiological findings with clinical outcomes to differentiate intussusceptions requiring emergent surgery for small bowel obstruction (SBO). Out of 35 acute patients, 9 patients required emergency surgery within 24 h. Intussusception caused SBO in five patients, and one patient had an internal herniation, while three patients had unremarkable findings. Eight patients were evaluated for intermittent pain with five unremarkable laparoscopies, while 18 patients had intussusceptions as incidental findings. Intussusception length on CT as measured by radiologists O.E. and D.L. predicted acute bowel obstruction (p = .014 and p < .001). A 100 mm threshold predicted bowel obstruction with a sensitivity of 80% and 100% and a specificity of 93% and 86% by radiologists O.E. and D.L., respectively. Proximal bowel dilatation predicted SBOs of any cause as well as SBO caused by an intussusception (all p < .05). 3
40. Patel P, Bhogal R, Rajput A, et al. Post Roux-en-Y gastric bypass complications: A comparative study assessing the clinical effectiveness of oesophagogastroduodenoscopy and oral-contrast swallow. Surgeon Journal of the Royal Colleges of Surgeons of Edinburgh & Ireland. 15(4):196-201, 2017 Aug. Review/Other-Dx 112 patients that underwent 1 or more OGD To compare whether Oesophagogastroduodenoscopy (OGD) or oral-contrast swallow should be employed in patient presenting with post-operative complications following RYGB. 75% (n = 67) of patients were diagnosed with a post-operative complication with the most common, 51% (n = 57) being a gastrojejunal anastomotic stricture. 82% (n = 47) of patients presented with dysphagia + - vomiting prior to the diagnosis of gastrojejunal anastomotic strictures. 96% (n = 55) of patients with gastrojejunal anastomotic strictures were successfully treated with balloon dilation. 48% (n = 54) of patients had an oral-contrast swallow as a first line investigation for post-operative symptoms prior to the OGD. 15% (n = 8) of oral-contrast swallow were reported with a significant pathology, with only 1 stricture identified. 70% (n = 38) of oral-contrast swallows reported as normal had a pathology identified at OGD, including 28 strictures. 4
41. Krishna S, McInnes MDF, Schieda N, Narayanasamy S, Sheikh A, Kielar A. Diagnostic Accuracy of MRI for Diagnosis of Internal Hernia in Pregnant Women With Prior Roux-en-Y Gastric Bypass. AJR. American Journal of Roentgenology. 211(4):755-759, 2018 10. Observational-Dx 15 registered pregnant women (8 with surgically proven IH, 7 without IH) who had previously undergone RYGB underwent MRI to rule out IH To evaluate the accuracy of MRI for the diagnosis of internal hernia (IH) in pregnant women who have undergone Roux-en-Y gastric bypass (RYGB). There were no statistically significant differences in patient age (p = 0.68), gestational age (p = 0.35), or time since RYGB (p = 0.55) between patients with and those without IH. The findings with best DOR and interobserver agreement were beaking of the superior mesenteric vein (reader 1 DOR, 39; reader 2 DOR, 39; ? = 1.00), mesenteric swirl (reader 1 DOR, 11; reader 2 DOR, 39; ? = 0.86), engorgement of mesenteric vessels (reader 1 DOR, 24; reader 2 DOR, 15; ? = 0.84), and mesenteric edema (reader 1 DOR, 11; reader 2 DOR, 3; ? = 0.73). The other findings had either low accuracy, poor interobserver agreement, or both. The overall sensitivity and specificity of the diagnosis of IH ranged from 75% to 88% and 86% to 100% for the two readers. There was no difference in diagnostic accuracy between the three methods (p = 0.93). 2
42. Van Berkel B, Gillardin P, Sneyers V, et al. Diagnostic accuracy of a fast MRI T2-sequence for the diagnosis of internal herniation after Roux-and-Y gastric bypass during pregnancy: A retrospective single center study. European Journal of Radiology. 151:110318, 2022 Jun. Observational-Dx 16 patients with IH and 15 patients without IH To evaluate the diagnostic accuracy of a fast sequence Magnetic Resonance Imaging (MRI) sequence, T2- half-Fourier acquisition single-shot turbo spin echo (HASTE) for the diagnosis of internal herniation (IH) in pregnant patients with a history of Roux-en-Y gastric bypass (RYGB). The results in this study, with 16 patients with IH and 15 patients without IH, portray a high accuracy for the detection of IH, ranging from 87.9% to 90.3%. This fast T2 sequence shows a high NPV (86.7% - 100.0% 87.7), sensitivity (88.9% - 100.0%) and specificity (80.0% - 86.7%). This study also portrayed a substantial interobserver agreement (0.741) for the evaluation of IH. 3
43. Bonouvrie DS, van Beek HC, Taverne SBM, et al. Pregnant Women After Bariatric Surgery: Diagnostic Accuracy of Magnetic Resonance Imaging for Small Bowel Obstruction. Obesity Surgery. 32(2):245-255, 2022 02. Observational-Dx 27 original MRI reports of pregnant women with RYGB suspected for SBO To describe the diagnostic accuracy of MRI for small bowel obstruction (SBO) during pregnancy. Twenty-four (89%) MRIs were of good quality. Sensitivity was 67% (confidence interval (CI) 0.43-0.85), specificity 67% (CI 0.13-0.98), PPV 93% (CI 0.66-0.99), and NPV 22% (CI 0.04-0.60). MRI was unable to detect SBO in 1 out of 3 patients. The presence of swirl sign, SBO sign, or clustered loop sign increases the likelihood of SBO. The interobserver agreement was overall wide, with the highest score for swirl sign (? 0.762). 2
44. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
45. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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