Most Lap-Band problems are diagnosed with a few standard tests. An upper GI X-ray (barium swallow) shows where the band sits, the size of the pouch and how well liquid flows through. A port study checks the port and tubing for leaks. An upper endoscopy looks inside the esophagus and stomach and is the main way to confirm erosion. A CT scan and reflux testing are used in some cases.
Where to start
An American Family Physician review (Kodner and Hartman, 2014) recommends that for a band patient with abdominal pain, vomiting or trouble swallowing, the recommended first steps are checking the port system and imaging the upper GI tract. The choice of test then depends on your symptoms. This table is a quick guide; each test is explained below.
| Test | What it mainly shows | Often used for |
|---|
| Upper GI series (barium swallow) | Band position and angle, pouch size, esophagus width, flow through the band | Slip, pouch dilation, esophageal dilation, blockage |
| Plain X-ray | Band angle and port position | Quick first look for a slip or a flipped port |
| Port and tubing study | Contrast flowing through port and tubing | Leaks, disconnections, fluid loss |
| Upper endoscopy | Inside lining of esophagus and stomach | Erosion, inflammation, ulcers, stuck food |
| CT scan | Band, tubing and surrounding organs | Severe pain, infection, abscess |
| pH testing and manometry | Acid in the esophagus and how its muscles move | Reflux, suspected motility problems |
Upper GI series (barium swallow)
You stand or lie on an X-ray table and swallow a contrast liquid while a radiologist watches on a live X-ray screen (fluoroscopy). The review by Monkhouse and colleagues in the Annals of the Royal College of Surgeons of England calls a two-view barium swallow "the investigation of choice" for a suspected slip. The Eid review in the Canadian Journal of Surgery agrees that slippage is diagnosed by upper GI series.
Radiologists look at the angle of the band, how far it sits below the diaphragm, and whether fluid pools above it. A 2014 study in the American Journal of Roentgenology found that an air-fluid level above the band, and a band more than 2.4 cm below the diaphragm, were both highly accurate for slippage. The same X-ray can measure the esophagus; one study (Milone and colleagues, 2008) counted an esophagus 35 mm or wider as dilated. See Lap-Band slippage and trouble swallowing.
Plain X-ray and port studies
A plain abdominal X-ray takes seconds. According to Monkhouse and colleagues, it can show a band lying horizontally instead of at its normal diagonal angle, which suggests a slip. It also shows where the port is and whether it has turned over.
A port study checks the port and tubing. The Eid review describes injecting dilute contrast into the port under fluoroscopy to find exactly where fluid escapes. Drawing back the fluid and measuring it is also informative: in a slow leak, less comes out than was put in. The FDA labeling also describes using an X-ray screen to guide the needle into a port that is hard to reach. See port and tubing problems.
Upper endoscopy
A thin, flexible camera is passed through your mouth into the esophagus and stomach. It shows the lining directly, which X-rays cannot. Kodner and Hartman state that an upper GI study or CT "may suggest" erosion, but that it is confirmed on upper endoscopy; the Eid review says the diagnosis "is often made at the time of gastroscopy." Endoscopy can also show inflammation from reflux and can be used to remove food lodged at the band. Before a removal or conversion, an endoscopy is a usual part of the evaluation described on our Lap-Band revision page. The office will confirm by phone where endoscopy and imaging are done.
CT scans, reflux testing and other tests
CT scan. A CT may be ordered when pain is severe or infection is suspected. In a 2019 study of 160 band patients who had CT scans for any reason (Kerpel and colleagues), band-related findings appeared in 43%. More than half were found incidentally, and some of those were clinically important. Findings included esophageal dilation, abscesses, erosions and disconnected tubing.
pH testing and manometry. Kodner and Hartman name a pH probe, which measures acid in the esophagus, and endoscopy as ways to diagnose reflux with a band. Manometry measures the squeezing of the esophagus. The FDA labeling leaves it to the surgeon to decide when motility studies are needed. In one series (Arias and colleagues, 2009), normal manometry before surgery did not predict who later developed a severely widened esophagus. See reflux with a Lap-Band.
Ultrasound and blood tests. For a red, painful port, Kodner and Hartman list examination and abdominal ultrasound to look for infection, and a blood count to check for infection when the skin over a prominent port looks irritated.
Frequently asked questions
What is the difference between an upper GI X-ray and an endoscopy?
An upper GI X-ray shows shapes and movement: where the band sits, how big the pouch is, and how liquid flows. An endoscopy shows the inside lining, so it can find erosion, ulcers or inflammation that an X-ray may miss. They answer different questions, and a surgeon planning a revision often wants both.
Do I need a test before every fill?
Not usually. Routine fills are often done based on your symptoms and weight. A test makes more sense when something has changed: new reflux, food sticking, vomiting, or restriction that disappears soon after each fill. In those cases adding fluid without knowing the cause can make things worse.
Why would a test be needed if I feel fine?
Some band problems cause few symptoms at first. In the FDA trial, some slips were found only on X-ray in people without symptoms, and in the CT study above, more than half of band-related findings were incidental. If your band was placed many years ago and has not been checked, a baseline test can be reasonable.
Are these tests safe if I am or might be pregnant?
Tell the staff before any X-ray, fluoroscopy or CT. These tests use radiation, and the FDA labeling advises shielding reproductive areas during radiography. Your doctor may choose a different test or timing. The FDA labeling also notes that people who become pregnant with a band may need fluid removed.
Talk with Dr. Davtyan in Rancho Cucamonga
Dr. David G. Davtyan, MD, FACS, FICS, FASMBS, is a bariatric surgeon and has a Lap-Band himself. Bring any recent imaging or endoscopy reports to the Rancho Cucamonga office at 8330 Red Oak Street, Suite 201, Rancho Cucamonga, CA 91730. Call 909-355-2525 or toll free 877-9-BE-SLIM (877-923-7546), or use the contact page; the first consultation is complimentary and Hablamos Español. The Rancho Cucamonga Lap-Band guide has more.
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