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Digestive Diseases and Sciences

, Volume 63, Issue 11, pp 3091–3096 | Cite as

Role of Diagnostic Preoperative Upper Gastrointestinal Endoscopy in Radiologically Confirmed Gastric Volvulus

  • Guilherme Piovezani Ramos
  • Shounak Majumder
  • Karthik Ravi
  • Seth Sweetser
Original Article

Abstract

Background and Aims

Gastric volvulus (GV) is a life-threatening condition that warrants prompt diagnosis and treatment. GV is a radiologic diagnosis. The role of preoperative upper gastrointestinal endoscopy (UGIE) for individuals with radiologically confirmed GV is poorly defined. Our objective was to assess the diagnostic yield of UGIE in the preoperative evaluation of patients presenting with radiologically confirmed GV.

Methods

Retrospective review of all adult patients undergoing surgery for GV between July 1996 and August 2016 has been carried out. We performed analyses evaluating diagnostic yield of preoperative UGIE and compared outcomes in patients who did and did not undergo preoperative UGIE. Outcomes were diagnostic yield of preoperative UGIE, length of hospital stay, postoperative complications, and mortality at 30 days and 1 year.

Results

In the preoperative UGIE group, the diagnostic yield was 34.6% (27/78). The most common endoscopic findings were erosive esophagitis (13/27) and clean based gastric or duodenal ulcers (5/27). There were no cases of esophago-gastric malignancy. Three patients had ulcers with stigmata of recent bleeding, and three patients had features suggestive of gastric ischemia. Endoscopic findings did not influence surgical management. There was no statistically significant difference in mortality between patients who did and did not undergo preoperative UGIE, both at 30 days (0 vs. 2.5%) and 1 year (3.8 vs. 7.5%).

Conclusion

Among patients with radiologically confirmed GV, preoperative UGIE rarely demonstrates clinically significant findings and can potentially delay definitive surgical intervention.

Keywords

Gastric volvulus Endoscopy Diagnostic yield Surgery 

Abbreviations

CT

Computerized tomography

GV

Gastric volvulus

HR

Heart rate

ICU

Intensive care unit

PEG

Percutaneous endoscopic gastrostomy

SBP

Systolic blood pressure

UGIE

Upper gastrointestinal endoscopy

Notes

Author's contribution

GPR contributed to study concept, acquisition of data, statistical analysis, and drafting of the manuscript. SM contributed to statistical analysis, analysis of the data, and critical revision of the manuscript. KR critically revised the manuscript for important intellectual content. SS contributed to study concept, design, and critical revision of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declared that they have no conflict of interest.

Ethical approval

The study was approved by the Mayo Clinic Institutional Review Board.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Guilherme Piovezani Ramos
    • 1
  • Shounak Majumder
    • 2
  • Karthik Ravi
    • 2
  • Seth Sweetser
    • 2
  1. 1.Department of Internal MedicineMayo ClinicRochesterUSA
  2. 2.Division of Gastroenterology and Hepatology, Mayo Clinic College of MedicineMayo ClinicRochesterUSA

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