Radiological Demonstration of Small Bowel Adaptation following a Modified Scopinaro Procedure for Morbid Obesity

Upper gastrointestinal contrast studies were carried out on 24 patients at progressive time intervals following gastric partition with partial biliopancreatic bypass (modified Scopinaro procedure) for morbid obesity. Roentgenograms taken on standardized equipment were compared in order to document adaptive changes occurring in the small bowel with time following the procedure. Mucosal fold thickness and bowel lumen calibre within the terminal ileum were found to increase significantly with (log) time. Such adaptation of the ileum is well recognized following jejunoileal bypass, but radiological demonstration after biliopancreatic bypass has not been described previously. Mucosal hypertrophy and increase in bowel lumen calibre should be recognized as normal adaptive changes in the small bowel and not be misinterpreted as evidence of underlying pathology. Whilst adaptation following jejunoileal bypass undoubtedly contributes to eventual weight gain following surgery, this detrimental effect following the modified Scopinaro procedure appears to be negated by the reduced intake and maldigestion imposed by this procedure