CHICAGO, Nov. 27 /PRNewswire/ -- Obese patients who suffer
complications after gastric bypass surgery may face further health risks
because their weight exceeds the limits of diagnostic imaging equipment,
according to a study presented today at the annual meeting of the
Radiological Society of North America (RSNA). In the study, approximately
27 percent of patients weighing more than 450 pounds needed imaging to
diagnose a problem after surgery and could not be accommodated because of
their size.
"When patients weigh more than 450 pounds, standard diagnostic imaging
often cannot be used," said Raul N. Uppot, M.D., an assistant radiologist
at Massachusetts General Hospital (MGH) and instructor of radiology at
Harvard Medical School in Boston. "In these cases, physicians must resort
to other means of diagnosis such as exploratory surgery or using less
accurate or more invasive techniques."
According to the Centers for Disease Control and Prevention, obesity
has grown dramatically in the last 20 years. Today, nearly one-third of the
American population is obese. Along with the rise in obesity among American
adults has come an increase in the number of gastric bypass procedures
performed. The American Society for Bariatric Surgery estimated
approximately 140,000 gastric bypass procedures were performed in the
United States in 2005. In a gastric bypass procedure, the stomach is
surgically reduced, and part of the small intestine is bypassed. Like any
surgical procedure, gastric bypass is not without risks. Most common
complications include suture tears and leaks, pulmonary embolism, pneumonia
and infection. Serious complications tend to be more prevalent among the
severely overweight.
Dr. Uppot and colleagues conducted an eight-year retrospective study of
all patients weighing more than 450 pounds who underwent a gastric bypass
procedure at MGH between June 1999 and April 2007. Patient imaging usage
and clinical course were tracked using electronic health records and
evaluated to determine the outcomes of those who, based on their weight,
were denied their physicians' first choice of imaging. The maximum weight
limit for a computed tomography (CT) table is 450 pounds.
The researchers found that 12 (27 percent) of the 44 patients who
weighed more than 450 pounds required postsurgical imaging because of a
clinical condition, but were denied because they were above the weight
restriction for the equipment. Four patients who could not be evaluated
with imaging for suspected leaks were required to return for surgery. Two
additional patients with suspected lung blood clots could not undergo a
chest CT. Of two patients who came in with nonspecific abdominal pain, one
was evaluated with ultrasound and the other one had a barium swallow test.
Because imaging was not an option, one patient who suffered trauma
underwent exploratory surgery in lieu of noninvasive imaging. Another
patient was denied a chest CT and received no further imaging evaluation.
"When obese patients cannot be diagnosed using standard-of-care imaging
techniques, then other diagnostic measures have to be instituted," Dr.
Uppot said. "Patient care may be ultimately affected due to a compromised
diagnosis."
Dr. Uppot noted that the obesity trend cannot be ignored. "Unless major
changes are made to the American diet or exercise habits, this is a problem
that we will have to address," he said. "When an obese person is
contemplating gastric bypass surgery, he or she should consider that they
will need follow- up imaging but may not be able to get the appropriate
tests."
Co-authors of the paper presented by Dr. Uppot are D.V. Sahani, M.D.,
D.A. Gervais, M.D., P.R. Mueller, M.D., P.F. Hahn, M.D., Ph.D., and S.I.
Lee, M.D., Ph.D.
AT A GLANCE
-- Gastric bypass patients who need diagnostic imaging performed to help
diagnose surgical complications may not be able to get it.
-- Approximately 27 percent of gastric bypass patients weighing more than
450 pounds could not get necessary diagnostic imaging after surgery
because they were heavier than the equipment weight limit.
-- Alternative means of diagnosis may be less accurate and more invasive.
-- Nearly one-third of the U.S. population is obese.
Note: Copies of RSNA 2007 news releases and electronic images will be
available online at RSNA.org/press07 beginning Monday, Nov. 26.
RSNA is an association of more than 41,000 radiologists, radiation
oncologists, medical physicists and related scientists committed to
excellence in patient care through education and research. The Society is
based in Oak Brook, Ill. (RSNA.org)
Editor's note: The data in these releases may differ from those in the
printed abstract and those actually presented at the meeting, as
researchers continue to update their data right up until the meeting. To
ensure you are using the most up-to-date information, please call the RSNA
Newsroom at 1-312-949-3233.
SOURCE Radiological Society of North America
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