title: Retrospective review of the preoperative biliary and gastrointestinal evaluation for gastric bypass surgery.
abstract: BACKGROUND
  The purpose of this study was to analyze the frequency and results of preoperative biliary and gastrointestinal (GI) evaluation of patients undergoing Roux-en-Y gastric bypass (RYGB).
  
  
  METHODS
  Retrospective review of the preoperative evaluation of 144 consecutive RYGB patients.
  
  
  RESULTS
  Cholecystectomy had already been performed in 43 (30%) patients; 22% of those patients with an intact gallbladder had cholelithiasis. Ten patients (7%) had an upper GI x-ray (UGI), and 94 patients (65%) had an esophagogastroduodenoscopy (EGD). Abnormalities were found in 40% of the UGIs and 84% of the EGDs. A total of 96 patients (67%) were tested for Helicobacter pylori; 11% were positive. Twenty-one patients (15%) underwent preoperative colonoscopy; 48% were abnormal, but most of the abnormalities were not clinically significant. Three patients had barium enema x-ray, which was normal in all cases.
  
  
  CONCLUSIONS
  The preoperative biliary and GI evaluation of bariatric surgery patients should include a routine ultrasound of the gallbladder. Routine preoperative EGD will detect a significant number of abnormalities that should be treated, but should rarely alter the bariatric surgical procedure or result in denial of bariatric surgery. Many abnormalities will be asymptomatic. Patients should be routinely screened for H. pylori and, if positive, treated before bariatric surgery. Lower GI evaluation should be performed selectively based on the patient's symptoms, physical findings, and guidelines for colorectal cancer and polyp screening.
authors.affiliation: St. Elizabeth and St. Joseph Surgical Weight Loss Center, Youngstown, 44501, USA. vince_vanek@hmis.org
authors.forename: Vincent W
authors.initials: VW
authors.lastname: Vanek
authors.forename: Michele
authors.initials: M
authors.lastname: Catania
authors.forename: Kimberly
authors.initials: K
authors.lastname: Triveri
authors.forename: Robert W
authors.initials: RW
authors.lastname: Woodruff
mesh_terms: D000328:Adult; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D041761:Cholecystolithiasis / Q000000981:diagnostic imaging / Q000453:epidemiology; D004381:Duodenal Ulcer / Q000453:epidemiology; D016145:Endoscopy, Digestive System; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging; D015390:Gastric Bypass; D016481:Helicobacter Infections / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000601:surgery; D011300:Preoperative Care; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000453:epidemiology; D014463:Ultrasonography; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid