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Evaluation of post operative gastro duodenal symptoms endoscopy or upper gastro intestinal roentgenography

Evaluation of post operative gastro duodenal symptoms endoscopy or upper gastro intestinal roentgenography

Surgery (St Louis) 86(4): 578-582

New or recurrent upper gastrointestinal symptoms are likely to occur in 15% to 20% of patients who have had a previous gastroduodenal operation. Onset of such symptoms may occur days to years following operation. Upper gastrointestinal roentgenography, the traditional mode of examination of the upper gastrointestinal tract, is often unreliable in establishing a correct diagnosis in such patients. To ascertain the reliability of roentgenographic examination as opposed to fiberoptic endoscopy, the diagnostic accuracy of both modalities was compared in 142 consecutive patients who had undergone previous upper gastrointestinal operation. This comparison encompassed a 4 yr period and involved a university-affiliated teaching hospital, a Veterans Administration hospital and 5 private hospitals. These examinations were undertaken during a period from 2 wk to more than 20 yr ofllowing operation. The diagnosis as disclosed by roentgenographic examination was incorrect or incomplete in 71 patients (50%). Of the 71 patients, 30 (42%) required operations to treat conditions diagnosed endoscopically that were missed on roentgenographic examination. Furthermore, in 19 patients (27%) endoscopic examination disproved a roentgenographic diagnosis which would have led to an unnecessary operation. In 22 patients (31%) no alteration in therapy resulted from the roentgenographic diagnostic inaccuracies. No particular anatomic reconstruction examined after operation was associated with an increased or decreased likelihood of incorrect diagnosis by roentgenographic examination. Thus 35% of the patients in this series had a major revision in therapy following endoscopic examination which altered or corrected a diagnosis disclosed roentgenographically. The high rate of diagnostic inaccuracy and the potential for inappropriate treatment associated with upper gastrointestinal roentgenographic examination emphasize the necessity for upper gastrointestinal endoscopy in every patient who has had any gastroduodenal operation and presents with significant persisting upper gastrointestinal symptoms.

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Accession: 005400614

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PMID: 483167

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