Utility of barium studies for patients with recurrent weight gain after Roux-en-Y gastric bypass

•Only 14% of patients with recurrent weight gain after gastric bypass had GGFs.•The majority of patients with recurrent weight gain had a large pouch/wide GJA.•Many patients without recurrent weight gain also had a large pouch/wide GJA.•Those with weight gain and a large pouch/wide GJA are likely to benefit from surgery.

AimTo determine the utility of barium studies for detecting abnormalities responsible for recurrent weight gain after gastric bypass surgery.MethodsA computerized search identified 42 patients who had undergone barium studies for recurrent weight gain after gastric bypass and 42 controls. The images were reviewed to determine the frequency of staple-line breakdown and measure the length/width of the pouch and gastrojejunal anastomosis. A large pouch exceeded 6 cm in length or 5 cm in width and a wide anastomosis exceeded 2 cm. Records were reviewed for the amount of recurrent weight gain and subsequent weight loss after additional treatment.ResultsStaple-line breakdown was present in 6/42 patients (14%) with recurrent weight gain. When measurements were obtained, 13/35 patients (37%) with recurrent weight gain had a large pouch, three (9%) had a wide anastomosis, and four (11%) had both, whereas 22/42 controls (52%) had a large pouch, one (2%) had a wide anastomosis, and two (5%) had both. Ten patients (24%) with recurrent weight gain underwent staple-line repair (n = 3) or pouch/anastomosis revision (n = 7). These 10 patients had a mean weight loss of 38.1 lbs versus a mean loss of 8.6 lbs in 19 patients managed medically.ConclusionOnly 14% of patients with recurrent weight gain after gastric bypass had staple-line breakdown, whereas 57% had a large pouch, wide anastomosis, or both. Not all patients with abnormal anatomy had recurrent weight gain, but those who did were more likely to benefit from surgical intervention than from medical management.