Value of preoperative esophagogastroduodenoscopy in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass.
BACKGROUND
Roux-en-Y gastric bypass hinders post-operative endoscopic evaluation of the upper gastrointestinal tract. Our aims were to determine the prevalence of preoperative endoscopic findings in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) and to determine the proportion of patients in which these findings changed surgical management.


METHODS
We retrospectively evaluated electronic medical records of patients undergoing esophagogastroduodenoscopy (EGD) with routine antral biopsy for Helicobacter pylori (HP) detection, prior to LRYGB between January 2003 and January 2010 at our institution. The prevalence of all endoscopic findings was determined.


RESULTS
652 underwent preoperative endoscopy prior to LRYGB. The mean age was 39.5 +/- 11.3 years and mean body mass index was 42.8 +/- 5.0 kg/m2. Abnormalities were found in 444 patients (68.1%). Findings at EGD were hiatal hernia 24.3% (n = 159), esophagitis 30.8% (n = 201), Barrett's esophagus 0.8% (n = 5), gastritis 36.2% (n = 236), gastric or duodenal ulcers 7.5% (n = 69) and 2 cases of gastric cancer. The prevalence of HP infection was 17.6% (n = 115). In 51 patients (7.8%), endoscopic findings led to postponement of surgery: in 49 patients, gastric or duodenal ulcer had to be treated prior to surgery, in 2 patients, gastric cancer led to changement in surgical approach.


CONCLUSIONS
Routine preoperative EGD detects different abnormalities which need a specific approach prior to bariatric surgery. EGD with routine biopsies for HP detection should be included in the preoperative workup prior to LRYGB. Positive EGD findings led to a change in medical treatment in a quarter (24.3%) of patients. Postponement of surgery due to the EGD findings was less frequent (7.8%).
Dept. of Digestive Surgery, Groeninge Hospital, Kortrijk, Belgium.
M
M
D'Hondt
M
M
Steverlynck
H
H
Pottel
A
A
Elewaut
C
C
George
F
F
Vansteenkiste
F
F
Van Rooy
D
D
Devriendt
D000328:Adult; D001530:Belgium / Q000453:epidemiology; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology