title: Preoperative upper gastrointestinal endoscopy in obese patients undergoing bariatric surgery: is it necessary?
abstract: BACKGROUND
  Obesity has been shown to be an important risk factor for several gastrointestinal diseases. However, the indication for preoperative upper gastrointestinal endoscopy (UGE) for all patients before bariatric surgery is controversial. The aim of the present study was to evaluate the spectrum of gastrointestinal diseases detected during preoperative UGE in patients undergoing bariatric surgery and the relevance of this procedure.
  
  
  METHODS
  A series of severely obese patients, who had undergone UGE before Roux-en-Y gastric bypass from October 2004 to May 2005 were consecutively enrolled in this study. The demographic and clinical data and endoscopic diagnoses were evaluated. Gastric biopsies were performed in elective patients according to the endoscopic findings.
  
  
  RESULTS
  The study included 162 patients, 69.8% of whom were women. The mean age was 36.7 +/- 10.8 years. Abnormal findings were observed in 77.2% of patients. Esophagitis was present in 38.9%, gastritis in 51.2% (erosive gastritis in 49.3% and nonerosive gastritis in 50.7%), gastric ulcers in 1.9%, hiatal hernia, in 8.6%, gastric polyp in .6%, and duodenitis in 6.8% of patients. No patient had esophageal or gastric varices. Helicobacter pylori infection was investigated in 96 patients and was detected in 37.5%. Gastric biopsies were performed in 36 patients, with chronic inflammation found in 72.2%, inflammatory activity in 30.6%, and intestinal metaplasia in 11.1%. Glandular atrophy was not found in any patient.
  
  
  CONCLUSIONS
  The results of our study have shown that the spectrum of gastrointestinal diseases observed in severely obese patients who underwent bariatric surgery is broad. Although this issue remains highly controversial, these findings suggest that systematic preoperative UGE and H. pylori testing should be performed in all patients scheduled to undergo bariatric surgery.
authors.affiliation: Federal University of Bahia Medical School, Salvador, Bahia, Brazil.
authors.forename: Alessandro
authors.initials: A
authors.lastname: de Moura Almeida
authors.forename: Helma Pinchemel
authors.initials: HP
authors.lastname: Cotrim
authors.forename: Adimeia Souza
authors.initials: AS
authors.lastname: Santos
authors.forename: Almir Galvão Vieira
authors.initials: AG
authors.lastname: Bitencourt
authors.forename: Daniel Batista Valente
authors.initials: DB
authors.lastname: Barbosa
authors.forename: Ana Piedade
authors.initials: AP
authors.lastname: Lobo
authors.forename: Adriano
authors.initials: A
authors.lastname: Rios
authors.forename: Erivaldo
authors.initials: E
authors.lastname: Alves
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D001706:Biopsy; D016009:Chi-Square Distribution; D015897:Comorbidity; D016099:Endoscopy, Gastrointestinal; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011300:Preoperative Care; D012307:Risk Factors; D018709:Statistics, Nonparametric