Role of Diagnostic Preoperative Upper Gastrointestinal Endoscopy in Radiologically Confirmed Gastric Volvulus
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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.
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.
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%).
Among patients with radiologically confirmed GV, preoperative UGIE rarely demonstrates clinically significant findings and can potentially delay definitive surgical intervention.
KeywordsGastric volvulus Endoscopy Diagnostic yield Surgery
Intensive care unit
Percutaneous endoscopic gastrostomy
Systolic blood pressure
Upper gastrointestinal endoscopy
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.
The study was approved by the Mayo Clinic Institutional Review Board.