Original articleScreening endoscopy before bariatric surgery: a series of 448 patients
Section snippets
Methods
A consecutive series of morbidly obese (body mass index >40 kg/m2 or >35 with significant co-morbidity) patients from October 2004 to August 2006 had successfully been cleared by our multidisciplinary team for bariatric surgery. This preoperative evaluation included pulmonary, cardiac (for gastric bypass patients or anyone with significant risk factors), psychological, and nutritional evaluations, as well as psychological and nutritional counseling. All patients were required to undergo
Results
During the 23-month study period, 448 patients were cleared for bariatric surgery and scheduled for EGD as a final evaluation before their surgery. Of the 448 patients, 447 successfully underwent EGD. These patients were mostly (87%) women, with an average age of 41 years (Table 1). The average body mass index was 47 kg/m2, and most (85%) patients had a body mass index of 40–59.9 kg/m2. In addition, 93% of patients had significant co-morbidities (Table 1). The most common were sleep apnea,
Discussion
Controversy exists concerning the role of preoperative EGD before bariatric surgery. Some have advocated its routine use for various reasons. For instance, upper gastrointestinal lesions have been found in 6–37% of patients [5], [6], [7], [8]. If any of these lesions were clinically significant, closing off most of the stomach to a relatively inaccessible state during gastric bypass could be inadvisable. Symptomatic or asymptomatic gastritis has been found in 30–51% of patients [9], [10],
Conclusion
In our experience, routine preoperative upper EGD reveals findings that alter surgical therapy in <.5% of cases. Incidental findings that led to an elective change in the preoperative medical therapy were found in about 20% of our patients. In >80% of patients, the EGD findings were either entirely negative or had no effect on the preoperative management or choice of surgery. During follow-up, anastamotic ulceration was found in 13% and was signficantly related to the endoscopic findings of
Disclosures
The authors claim no commercial associations that might be a conflict of interest in relation to this article.
References (13)
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report
Obes Res
(1998)- et al.
Obesity in the environment, where do we go from here?
Science
(2003) - et al.
Bariatric surgery utilization and outcomes in 1998 and 2004, statistical brief #23Agency for Healthcare Research and Quality 2007
- et al.
Endoscopy plays an important preoperative role in bariatric surgery
Obes Surg
(2004) - et al.
Value of preoperative upper endoscopy in patients undergoing laparoscopic gastric bypass
Obes Surg
(2006) - et al.
Is routine preoperative upper endoscopy in gastric banding patients really necessary?
Obes Surg
(2006)
Cited by (92)
Assessment and management of gastroesophageal reflux disease following bariatric surgery
2021, Surgery for Obesity and Related DiseasesRoutine preoperative endoscopy in patients undergoing bariatric surgery
2020, Surgery for Obesity and Related DiseasesIs routine preoperative esophagogastroduodenscopy prior to bariatric surgery mandatory? protocol for a systematic review and meta-analysis
2020, International Journal of Surgery ProtocolsGastroesophageal junction adenocarcinoma 1-year after sleeve gastrectomy
2023, Journal of Surgical Case Reports
Reprints not available from the authors.