title: Is esophagogastroduodenoscopy before Roux-en-Y gastric bypass or sleeve gastrectomy mandatory?
abstract: BACKGROUND
  Roux-Y Gastric Bypass is a frequently used technique in bariatric surgery. Postoperative anatomy is altered by exclusion of the stomach, which makes this organ inaccessible for future esophagogastroduodenoscopy (EGD). The value of preoperative assessment of the stomach is unclear. Some institutions choose to investigate the future remnant stomach by EGD, others do not. Aim of the present study is to quantify the yield of preoperative EGD in our institution.
  
  
  METHODS
  Patients, planned for primary laparoscopic Roux-Y Gastric Bypass (LRYGB) or laparoscopic sleeve gastrectomy from December 2007 until August 2012, were screened by EGD in advance. Results of EGD and patient characteristics were retrospectively analyzed and categorized according to a classification system based on intervention needed.
  
  
  RESULTS
  523 patients (122 male, 401 female, mean age 44.3 years, average BMI 46.6) underwent preoperative EGD. In 257 patients (48.9%) no abnormality was found (group A), 117 patients (17.2%) had abnormalities without treatment consequences (B1), 84 patients (of the 326 tested [comment #1, reviewer #1, 26.8%] were H. Pylori positive (B2), in 75 (14.3%) treatment with proton pump inhibitors was required (B3), 6 (1.1%) required follow up EGD before surgery (C). For1 patient (0.2%) the operation was canceled because preoperative EGD presented with Barrett's esophagus with carcinoma (D). When all abnormalities were taken into account, baselines did show a significant difference for age, gender and reflux symptoms.
  
  
  CONCLUSIONS
  Standard preoperative assessment by EGD in patients who are planned for bariatric surgery is not indicated. The number needed to screen to find clinically significant abnormalities is high.
authors.affiliation: Department of Surgery, Sint Lucas Andreas Ziekenhuis Amsterdam, The Netherlands.
authors.forename: Arvid
authors.initials: A
authors.lastname: Schigt
authors.affiliation: Department of Surgery, Sint Lucas Andreas Ziekenhuis Amsterdam, The Netherlands. Electronic address: u.coblijn@slaz.nl.
authors.forename: Usha
authors.initials: U
authors.lastname: Coblijn
authors.affiliation: Department of Surgery, Sint Lucas Andreas Ziekenhuis Amsterdam, The Netherlands.
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Lagarde
authors.affiliation: Department of Gastroenterology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Kuiken
authors.affiliation: Department of Gastroenterology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Scholten
authors.affiliation: Department of Surgery, Sint Lucas Andreas Ziekenhuis Amsterdam, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: van Wagensveld
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D018580:Mandatory Testing; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Bariatric surgery; Esophagogastroduodenoscopy; Gastric bypass; Morbid obesity; Preoperative; Screening; Upper endoscopy