Bariatric Times

JUL 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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open environment. However, both CT and MRI may be equally useful studies for the elective evaluation of nonspecific abdominal pain after gastric bypass. Insurance coverage for CT scans is almost universal, while precertification for MRI studies generally requires another level of approval. In our pilot study, the evaluation of post-bypass anatomy was identical between the two modalities. Additional incidental findings were more common after CT, and mandated additional work-up, some of which entailed even more IR, but further evaluation never led to significant findings. While the cost of MRI is somewhat higher than the cost of CT, the additional medical investigations necessitated by the CTs made the CT-related cost of care overall much higher. We suggest that MRI may be a superior modality for the elective work-up of gastric bypass patients with undifferentiated central abdominal pain, not only because of the lack of IR, thus conferring no additional cancer risk, but also because it may be equivalently diagnostic and overall more cost effective. We hope to pursue funding for a larger study to look for significant differences or similarities between the two modalities. REFERENCES 1. Cho M, Kaidar-Person O, Szomstein S, Rosenthal RJ. Emergency room visits after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Obes Relat Dis. 2008;4:104–109. 2. Mettler FA, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog 1. Radiology. 2008;248:254–263. 3. Semelka RC, Armao DM, Elias J, Huda W. Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI. J Magn Reson. 2007;25:900–909. 4. Rogers AM, Dudeck B, Winder J. Evidence for and potential causes of high postoperative radiation exposure in gastric bypass patients. Surg Obes Relat Dis. 2015;11:s86–87. 5. Sodickson A, Baeyens PF, Andriole KP, et al. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults 1. Radiology. 2009;251:175–184. 6. Greenstein AJ, O'rourke RW. Abdominal pain after gastric bypass: suspects and solutions. Am J Surg. 2011;201:819–827. FUNDING: Funded by the Penn State Association of Family and Friends. AUTHOR AFFILIATION: Ann Rogers, MD, is from The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania. Jared Cappelli, RN, BS, is from Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania. A DDRESS FOR CORRESPONDENCE: Ann M. Rogers, MD, The Pennsylvania State University, College of Medicine Department of Surgery, Division of Minimally Invasive/Bariatric Surgery; 500 University Drive, H149, Hershey, PA 17033-0850; Phone: (717) 531-7462; Fax: (717) 531-4729; E-mail: arogers@pennstatehealth.psu.edu 17 Original Research Bariatric Times • July 2017 We suggest that MRI may be a superior modality for the elective work-up of gastric bypass patients with undifferentiated central abdominal pain, not only because of the lack of IR, thus conferring no additional cancer risk, but also because it may be equivalently diagnostic and overall more cost effective.

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