Screening endoscopy before bariatric surgery: a series of 448 patients.
BACKGROUND
The role of upper esophagogastroduodenoscopy (EGD) in morbidly obese patients before bariatric surgery is controversial. The purpose of this study was to determine the diagnostic yield of routine EGD before bariatric surgery.


METHODS
A consecutive series of 448 morbidly obese patients, who were otherwise cleared for bariatric surgery, underwent routine EGD. The endoscopic findings were classified by the clinical significance. The findings were tabulated and analyzed.


RESULTS
A total of 447 patients (389 women and 58 men) underwent EGD successfully. Of the 447 patients, 85% had a body mass index of 40-59.9 kg/m(2), and 93% had significant co-morbidities. Abnormal findings that did not change the surgical approach or postpone surgery were found in 60 patients (13%), including hiatal hernia and benign polyps. Abnormal findings that changed the medical management before surgery were found in 81 patients (18%), including inflammation and/or ulcers. This group included 9 of 61 patients with gastritis who were treated for Helicobacter pylori found within the biopsy specimen. Findings that changed the surgical approach were found in 1 patient, and findings of severe ulcerations that postponed surgery were found in another patient. Of the 447 patients, 389 actually underwent bariatric surgery, including Roux-en-Y gastric bypass in 57% and adjustable gastric banding in 43%. During follow-up, 37 gastric bypass patients (13%) developed ulceration. Both gastritis and duodenitis, but not the presence of H. pylori, was statistically related to ulcer formation (Fisher's exact test).


CONCLUSIONS
In this consecutive series of 451 successful screening EGDs, positive findings led to a change in medical treatment in a significant number of patients (18%), but a change in the timing of surgery or the surgical technique in relatively few (<1%). In addition, a significant correlation between gastritis and postoperative anastamotic ulceration suggests a causative link, with implications arguing for stronger medical therapy. A randomized trial should be performed to validate the usefulness of preoperative EGD in bariatric patients.
Cape Cod Surgical Associates, Hyannis, Maine, USA.
Mark
M
Loewen
Jeanine
J
Giovanni
Carlos
C
Barba
D050110:Bariatric Surgery; D015992:Body Mass Index; D016009:Chi-Square Distribution; D003955:Diagnostic Tests, Routine; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*