title: Esophagogastric pathology in morbid obese patient: Preoperative diagnosis, influence in the selection of surgical technique.
abstract: BACKGROUND
  Given the difficulty in accessing to the excluded stomach after gastric bypass and the increase in gastroesophageal reflux after sleeve gastrectomy, it is justified to perform a preoperative fibrogastroscopy.The influence of the fibrogastroscopy (FGS) findings in the therapeutic approach is analyzed.
  
  
  METHODS
  A retrospective study of preoperative FGS findings is performed, from 04/06 to 12/12. The influence of the FGS results on the surgical technique selection, in the endoscopic or medical treatment and its relation to gastric fistula is analyzed by means of multivariate regression (confounding factors: Age, body mass index, arterial hypertension, diabetes mellitus, antiplatelet therapy, surgical technique (bariatric surgery, sleeve gastrectomy).
  
  
  RESULTS
  Three hundred thirty one patients are included: 32.6% biopsy of gastric lesion; 27% gastritis; 18.1% hiatal hernia; 3% metaplasia; 0.6% Barrett esophagus; 2.1% esophagitis; 0.3% dysplasia; 0.3 Schatzky&#180;s ring; 1.5% incompetent cardia; 2.4% duodenitis; 0.3% gastric erosions; 0.6% gastric xanthoma; 1.8%, gastric polyp; 1.6% duodenal ulcer; 0.6% papulo-erosive gastritis; 0.6% esophageal papilloma; 0.3% submucosal tumor. Helicobacter pylori+ 30.2% (triple therapy eradication in all patients). The FGS findings led to a variation in the surgical technique or to the completion of endoscopic treatment in 22.2% of cases.The gastric lesions did not influence the development of gastric fistula. Independent prognostic factors of fistula: Sleeve gastrectomy (7.9% vs. 2.7%; p = 0.02; OR: 1.38 IC95: 1.01-1.87) and the body mass index > 50 kg/m2) (6.7% vs. 2.2%; p = 0.04; OR: 3.7 IC95: 1.12-12.4).
  
  
  CONCLUSIONS
  The diagnosis of gastroesophageal disease through preoperative FGS motivated variations in the therapeutic approach in 52% of patients, so we consider essential to include the preoperative FGS in bariatric surgery.
authors.forename: Sergio
authors.initials: S
authors.lastname: Estévez-Fernández
authors.forename: Raquel
authors.initials: R
authors.lastname: Sánchez-Santos
authors.forename: Esther
authors.initials: E
authors.lastname: Mariño-Padín
authors.forename: Sonia
authors.initials: S
authors.lastname: González-Fernández
authors.forename: Juan
authors.initials: J
authors.lastname: Turnes-Vázquez
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D050110:Bariatric Surgery / Q000379:methods*; D000066491:Clinical Decision-Making / Q000379:methods*; D004935:Esophageal Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D015995:Prevalence; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D055815:Young Adult