Jiwon V Park1, Maxwell T Sievers1, Paris D Rollins1, Alyssa M Hardin1, Hootan M Omidvar1, Laura Mazer2, Allison R Schulman3,4. 1. University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA. 2. Department of Surgery, University of Michigan, Ann Arbor, MI, USA. 3. Department of Surgery, University of Michigan, Ann Arbor, MI, USA. arschulm@med.umich.edu. 4. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA. arschulm@med.umich.edu.
Abstract
BACKGROUND: Sleeve gastrectomy (SG) is the most common bariatric procedure performed. The incidence of gastric sleeve stenosis (GSS) is up to 4%, with a rising prevalence given increasing popularity of this surgery. GSS is best treated with pneumatic balloon dilation (PBD), but the diagnosis is not always straightforward, oftentimes leading to an extensive diagnostic workup. The aims of the current study were to quantify delay to treatment and overall healthcare utilization during this delay in patients with GSS following SG. METHODS: This was a retrospective review of a prospectively collected database including patients with SG diagnosed with GSS between October 2017 and September 2020. The primary outcome was time between symptom development and treatment with PBD. Secondary outcomes included total healthcare utilization as reflected by the number and charges of imaging and emergency room (ER) visits. RESULTS: Forty-five patients were included in the analysis; 37 (82%) were female. The mean (± SD) time to treatment was 755 (± 713) days. The probability of receiving treatment at 1, 2, and 3 years was 37%, 62%, and 76%, respectively. The mean (± SD) abdominal CT scans, radiographs, and UGIS between symptoms and PBD were 1.3 ± 2.0, 1.2 ± 1.6, and 1.2 ± 1.0, respectively. The mean number of ER visits was 1.9 ± 2.5 (range 0-8). The average number of diagnostic non-therapeutic upper endoscopies was 1.6 ± 1.5. The mean (± SD) total charges were $16,473 ± 15,173. CONCLUSION: Patients who develop GSS following SG experience significant delay in diagnosis and management, reflected by multiple imaging studies, emergency department visits, and non-therapeutic procedures.
BACKGROUND: Sleeve gastrectomy (SG) is the most common bariatric procedure performed. The incidence of gastric sleeve stenosis (GSS) is up to 4%, with a rising prevalence given increasing popularity of this surgery. GSS is best treated with pneumatic balloon dilation (PBD), but the diagnosis is not always straightforward, oftentimes leading to an extensive diagnostic workup. The aims of the current study were to quantify delay to treatment and overall healthcare utilization during this delay in patients with GSS following SG. METHODS: This was a retrospective review of a prospectively collected database including patients with SG diagnosed with GSS between October 2017 and September 2020. The primary outcome was time between symptom development and treatment with PBD. Secondary outcomes included total healthcare utilization as reflected by the number and charges of imaging and emergency room (ER) visits. RESULTS: Forty-five patients were included in the analysis; 37 (82%) were female. The mean (± SD) time to treatment was 755 (± 713) days. The probability of receiving treatment at 1, 2, and 3 years was 37%, 62%, and 76%, respectively. The mean (± SD) abdominal CT scans, radiographs, and UGIS between symptoms and PBD were 1.3 ± 2.0, 1.2 ± 1.6, and 1.2 ± 1.0, respectively. The mean number of ER visits was 1.9 ± 2.5 (range 0-8). The average number of diagnostic non-therapeutic upper endoscopies was 1.6 ± 1.5. The mean (± SD) total charges were $16,473 ± 15,173. CONCLUSION: Patients who develop GSS following SG experience significant delay in diagnosis and management, reflected by multiple imaging studies, emergency department visits, and non-therapeutic procedures.
Authors: Amit Parikh; Joshua B Alley; Richard M Peterson; Michael C Harnisch; Jason M Pfluke; Donovan M Tapper; Stephen J Fenton Journal: Surg Endosc Date: 2011-11-02 Impact factor: 4.584
Authors: Richard Welbourn; Marianne Hollyman; Robin Kinsman; John Dixon; Ronald Liem; Johan Ottosson; Almino Ramos; Villy Våge; Salman Al-Sabah; Wendy Brown; Ricardo Cohen; Peter Walton; Jacques Himpens Journal: Obes Surg Date: 2018-11-12 Impact factor: 4.129
Authors: Laura Mazer; Jessica X Yu; Sean Bhalla; Kevin Platt; Lydia Watts; Sarah Volk; Allison R Schulman Journal: Obes Surg Date: 2022-04-05 Impact factor: 3.479