In-office fluoroscopy is an underutilized tool in the work-up of the bariatric and foregut patient

TL;DR

In-office fluoroscopy is a helpful but underused tool for bariatric and foregut surgeons to evaluate patients before and after surgery.

Contribution

The paper highlights the underutilized clinical utility of in-office fluoroscopy in bariatric and foregut surgery.

Findings

Fluoroscopy provides valuable insights when conventional diagnostics are inconclusive.

Fluoroscopy can be used to accurately adjust gastric bands and evaluate postoperative symptoms.

Eleven representative cases demonstrate the practical benefits of in-office fluoroscopy.

Abstract

In-office fluoroscopy can be a useful tool for foregut and bariatric surgeons. It can be used to evaluate patients before and after surgery. Fluoroscopy provides a platform to teach patients about their anatomy and even be used to modify behavior. Based on our clinical experience, IOF appears to provide valuable insights in selected patient populations where conventional diagnostics are inconclusive Xu (BJR|case Rep 3:1-20160076, 2017).

Our experience with fluoroscopy began with the popularity of adjustable gastric bands. Our practice does not advocate for the blind access of band ports. Because there are multiple types of bands made by multiple companies we find that the blind accessing of ports and thus the blind guessing of the amount of fluid to put in or take out of a band is unacceptable. For years, we utilized fluoroscopy for our band patients to accurately and safely adjust their bands to create the desired amount of restriction [2]. As the band fill frequency and popularity has waned, we fortuitously found that fluoroscopy was helpful in other scenarios.

Between January 2019 and December 2024, patients presenting to our bariatric and foregut surgery clinic underwent IOF based on clinical indications, including postoperative symptoms, evaluation of prior surgical anatomy, or preoperative assessment for GERD. All procedures were performed using a GE Healthcare OEC One C-arm and interpreted by the attending surgeon.

We present 11 representive cases to illustrate the clinical utility of IOF. Patient consent for use of de-identified imaging and clinical data was obtained.

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