Diagnostic Yield and Clinical Implications of Preoperative Upper Gastrointestinal Endoscopy in Morbidly Obese Patients Undergoing Bariatric Surgery.
OBJECTIVE
Upper gastrointestinal (UGI) endoscopy in patients undergoing bariatric surgery is controversial. It is recommended routinely by some authors to detect benign or malignant pathology that mostly remains asymptomatic. Others recommend selective use, suggesting not much impact on surgical management of detected pathology, especially in asymptomatic patients. The aim of this study was to evaluate the diagnostic yield and impact of pathological findings on routine UGI endoscopy before bariatric surgery in a cohort of morbidly obese Indian patients.


METHODS
We retrospectively reviewed preoperative screening UGI endoscopy reports of 283 patients who underwent bariatric surgery from February 2012 to August 2014. Data were collected on clinical information, UGI endoscopic findings, Helicobacter pylori testing, and management.


RESULTS
Ten patients gave a history of gastroesophageal reflux, and the rest had no specific UGI complaints. Fifty-four had no abnormal findings. One hundred ninety-six had a lax lower esophageal hiatus, hiatal hernias of <5 cm, Grade I-II esophagitis, or mild to moderate gastritis or duodenitis that did not have an impact on surgery. Thirty-one had severe erosive gastritis or duodenitis, or polyposis that delayed surgery for treatment and review of biopsies. A large hiatal hernia >5 cm changed surgical plan to Roux-en-Y gastric bypass from a sleeve gastrectomy in 2 cases. None had varices or malignancy.


CONCLUSIONS
Preoperative UGI endoscopy yielded a high proportion of endoscopic abnormalities even in asymptomatic patients. Surgery was delayed to treat severe mucosal lesions and to investigate polypoidal findings in the majority. A change in surgical approach and surveillance for malignancy was needed in a few cases.
1 Department of Bariatric Surgery, GEM Hospital and Research Centre , Coimbatore, Tamil Nadu, India .
Palanivelu
P
Praveenraj
1 Department of Bariatric Surgery, GEM Hospital and Research Centre , Coimbatore, Tamil Nadu, India .
Rachel M
RM
Gomes
1 Department of Bariatric Surgery, GEM Hospital and Research Centre , Coimbatore, Tamil Nadu, India .
Saravana
S
Kumar
2 Department of Surgical Gastroenterology, GEM Hospital and Research Centre , Coimbatore, Tamil Nadu, India .
Palanisamy
P
Senthilnathan
2 Department of Surgical Gastroenterology, GEM Hospital and Research Centre , Coimbatore, Tamil Nadu, India .
Ramakrishnan
R
Parathasarathi
2 Department of Surgical Gastroenterology, GEM Hospital and Research Centre , Coimbatore, Tamil Nadu, India .
Subbiah
S
Rajapandian
2 Department of Surgical Gastroenterology, GEM Hospital and Research Centre , Coimbatore, Tamil Nadu, India .
Chinnusamy
C
Palanivelu
D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D001706:Biopsy; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D055815:Young Adult