title: Place of upper endoscopy before and after bariatric surgery: A multicenter experience with 3219 patients.
abstract: OBJECTIVE
  To study the preoperative and postoperative role of upper esophagogastroduodenoscopy (EGD) in morbidly obese patients.
  
  
  METHODS
  This is a multicenter retrospective study by reviewing the database of patients who underwent bariatric surgery (laparoscopic sleeve gastrectomy, laparoscopic Roux en Y gastric bypass, or laparoscopic minigastric bypass) in the period between 2001 June and 2015 August (Jahra Hospital-Kuwait, Hafr Elbatin Hospital and King Saud Medical City-KSA, and Mansoura University Hospital - Egypt). Patients with age 18-65 years, body mass index (BMI) > 40, or > 35 with comorbidities after failure of many dietetic regimen and acceptable levels of surgical risk were included in the study after having an informed signed consent. We retrospectively reviewed the medical charts of all morbidly obese patients. The patients' preoperative data included clinical history including upper digestive symptoms and preoperative full workup including EGD. Only patients whose charts revealed weather they were symptomatic or not were studied. We categorized patients accordingly into two groups; with (group A) or without (group B) upper digestive symptoms. The endoscopic findings were categorized into 4 groups based on predetermined criteria. The medical record of patients who developed stricture, leak or bleeding after bariatric surgery was reviewed. Logestic regression analysis was used to identify preoperative predictors that might be associated with abnormal endoscopic findings.
  
  
  RESULTS
  Three thousand, two hundred and nineteen patients in the study period underwent bariatric surgery (75% LSG, 10% LRYDB, and 15% MGB). Mean BMI was 43 ± 13, mean age 37 ± 9 years, 79% were female. Twenty eight percent had presented with upper digestive symptoms (group A). EGD was considered normal in 2414 (75%) patients (9% group A vs 66% group B, P = 0.001). The abnormal endoscopic findings were found high in those patients with upper digestive symptoms. Abnormal findings (one or more) were found in 805 (25%) patients (19% group A vs 6% group B, P = 0.001). Seven patients had critical events during conscious sedation due to severe hypoxemia (< 60%). Rate of stricture in our study was 2.6%. Success rate of endoscopic dilation was 100%. One point nine percent patients with gastric leak were identified with 75% success rate of endoscopic therapy. Three point seven percent patients developed acute upper bleeding. Seventy-eight point two percent patients were treated by conservative therapy and EGD was performed in 21.8% with 100% success and 0% complications.
  
  
  CONCLUSIONS
  Our results support the performance of EGD only in patients with upper gastrointestinal symptoms. Endoscopy also offers safe effective tool for anastomotic complications after bariatric surgery.
authors.affiliation: Mohamed E Abd Ellatif, Alaa Magdy, Waleed Thabet, Emad Abdallah, Asharf Shoma, Ibraheim E Dawoud, Ashraf Abbas, Department of Surgery, Mansoura University Hospital, Mansoura 35511, Dakahlia, Egypt.
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Abd Ellatif
authors.affiliation: Mohamed E Abd Ellatif, Alaa Magdy, Waleed Thabet, Emad Abdallah, Asharf Shoma, Ibraheim E Dawoud, Ashraf Abbas, Department of Surgery, Mansoura University Hospital, Mansoura 35511, Dakahlia, Egypt.
authors.forename: Haitham
authors.initials: H
authors.lastname: Alfalah
authors.affiliation: Mohamed E Abd Ellatif, Alaa Magdy, Waleed Thabet, Emad Abdallah, Asharf Shoma, Ibraheim E Dawoud, Ashraf Abbas, Department of Surgery, Mansoura University Hospital, Mansoura 35511, Dakahlia, Egypt.
authors.forename: Walid A
authors.initials: WA
authors.lastname: Asker
authors.affiliation: Mohamed E Abd Ellatif, Alaa Magdy, Waleed Thabet, Emad Abdallah, Asharf Shoma, Ibraheim E Dawoud, Ashraf Abbas, Department of Surgery, Mansoura University Hospital, Mansoura 35511, Dakahlia, Egypt.
authors.forename: Ayman E
authors.initials: AE
authors.lastname: El Nakeeb
authors.affiliation: Mohamed E Abd Ellatif, Alaa Magdy, Waleed Thabet, Emad Abdallah, Asharf Shoma, Ibraheim E Dawoud, Ashraf Abbas, Department of Surgery, Mansoura University Hospital, Mansoura 35511, Dakahlia, Egypt.
authors.forename: Alaa
authors.initials: A
authors.lastname: Magdy
authors.affiliation: Mohamed E Abd Ellatif, Alaa Magdy, Waleed Thabet, Emad Abdallah, Asharf Shoma, Ibraheim E Dawoud, Ashraf Abbas, Department of Surgery, Mansoura University Hospital, Mansoura 35511, Dakahlia, Egypt.
authors.forename: Waleed
authors.initials: W
authors.lastname: Thabet
authors.affiliation: Mohamed E Abd Ellatif, Alaa Magdy, Waleed Thabet, Emad Abdallah, Asharf Shoma, Ibraheim E Dawoud, Ashraf Abbas, Department of Surgery, Mansoura University Hospital, Mansoura 35511, Dakahlia, Egypt.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Ghaith
authors.affiliation: Mohamed E Abd Ellatif, Alaa Magdy, Waleed Thabet, Emad Abdallah, Asharf Shoma, Ibraheim E Dawoud, Ashraf Abbas, Department of Surgery, Mansoura University Hospital, Mansoura 35511, Dakahlia, Egypt.
authors.forename: Emad
authors.initials: E
authors.lastname: Abdallah
authors.affiliation: Mohamed E Abd Ellatif, Alaa Magdy, Waleed Thabet, Emad Abdallah, Asharf Shoma, Ibraheim E Dawoud, Ashraf Abbas, Department of Surgery, Mansoura University Hospital, Mansoura 35511, Dakahlia, Egypt.
authors.forename: Rania
authors.initials: R
authors.lastname: Shahin
authors.affiliation: Mohamed E Abd Ellatif, Alaa Magdy, Waleed Thabet, Emad Abdallah, Asharf Shoma, Ibraheim E Dawoud, Ashraf Abbas, Department of Surgery, Mansoura University Hospital, Mansoura 35511, Dakahlia, Egypt.
authors.forename: Asharf
authors.initials: A
authors.lastname: Shoma
authors.affiliation: Mohamed E Abd Ellatif, Alaa Magdy, Waleed Thabet, Emad Abdallah, Asharf Shoma, Ibraheim E Dawoud, Ashraf Abbas, Department of Surgery, Mansoura University Hospital, Mansoura 35511, Dakahlia, Egypt.
authors.forename: Ibraheim E
authors.initials: IE
authors.lastname: Dawoud
authors.affiliation: Mohamed E Abd Ellatif, Alaa Magdy, Waleed Thabet, Emad Abdallah, Asharf Shoma, Ibraheim E Dawoud, Ashraf Abbas, Department of Surgery, Mansoura University Hospital, Mansoura 35511, Dakahlia, Egypt.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Abbas
authors.affiliation: Mohamed E Abd Ellatif, Alaa Magdy, Waleed Thabet, Emad Abdallah, Asharf Shoma, Ibraheim E Dawoud, Ashraf Abbas, Department of Surgery, Mansoura University Hospital, Mansoura 35511, Dakahlia, Egypt.
authors.forename: Asaad F
authors.initials: AF
authors.lastname: Salama
authors.affiliation: Mohamed E Abd Ellatif, Alaa Magdy, Waleed Thabet, Emad Abdallah, Asharf Shoma, Ibraheim E Dawoud, Ashraf Abbas, Department of Surgery, Mansoura University Hospital, Mansoura 35511, Dakahlia, Egypt.
authors.forename: Maged
authors.initials: M
authors.lastname: Ali Gamal
keywords: Complications; Dilation; Endoscopy; Morbid obesity; Obesity surgery; Stenting