Importance of routine preoperative upper GI endoscopy: why all patients should be evaluated?
BACKGROUND
Morbid obesity is associated with different gastrointestinal alterations and diseases. Surgically induced weight loss has become the best treatment for morbidly obese patients. Roux-en-Y gastric bypass is the most common procedure performed worldwide. Concerns regarding difficulties in further evaluation of stomach remnant for early detection of gastric cancer, however, have emphasized the routine use of preoperative upper endoscopy, even in asymptomatic patients, to detect upper gastrointestinal abnormalities. The main outcome of this study was to identify the most common preoperative endoscopic findings.


METHODS
Data was collected from a prospective database and medical records of patients with available endoscopic reports, who underwent Roux-en-Y gastric bypass from February 1999 to June 2006. Logistic regression analysis was performed to detect preoperative clinical variables that might be associated with abnormal endoscopy.


RESULTS
Six hundred twenty-six patients were identified. Four hundred fifty-two (72%) were female; age and body mass index were 38.5 +/- 11.3 years and 42 +/- 6.5 kg/m(2), respectively. Abnormalities were found in 288 (46%) patients. The age of patients with abnormal and normal endoscopy was 40 +/- 11 and 36.8 +/- 11 years, respectively (p < 0.001). The most common findings were gastritis 21% (n = 132), esophagitis 16% (n = 100), and hiatal hernia 10.7% (n = 67). Duodenitis has a frequency of 7.8% (n = 49), gastric ulcers of 2.7%(n = 17), duodenal ulcers of 2.6% (n = 16), gastric polyps of 1.3% (n = 8), Barrett's esophagus of 0.16% (n = 1), and gastric cancer of 0.16% (n = 1). Age was the only clinical variable associated to abnormal endoscopy (odds ratio = 1.03; 95% confidence interval, 1.02-1.05).


CONCLUSIONS
Routine preoperative endoscopy detects different abnormalities which need specific approach prior to surgery. Preoperative endoscopy should be performed to all patients prior to surgery.
Muñoz
Rodrigo
R
Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
Ibáñez
Luis
L
Salinas
José
J
Escalona
Alex
A
Pérez
Gustavo
G
Pimentel
Fernando
F
Guzmán
Sergio
S
Boza
Camilo
C
D000328:Adult; D015897:Comorbidity; D003955:Diagnostic Tests, Routine; D016099:Endoscopy, Gastrointestinal; D004941:Esophagitis / Q000453:epidemiology; D005260:Female; D005756:Gastritis / Q000453:epidemiology; D016481:Helicobacter Infections / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology*; D011300:Preoperative Care / Q000592:standards*
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