title: Is Preoperative Upper Gastrointestinal Endoscopy in Obese Patients Undergoing Bariatric Surgery Mandatory? An Asian Perspective.
abstract: The role of routine preoperative oesopha gogastroduodenoscopy (OGD) for all bariatric surgery candidates is controversial. We aim to investigate the prevalence of clinically significant OGD findings in a primarily Chinese obese population and identify factors that predict a normal screening OGD.
  
  
  
  Medical records of patients who underwent primary bariatric surgery in our centre from August 2002 to December 2014 were reviewed. OGD findings were classified into two groups: group 1 consisted of normal findings and abnormal findings that would not alter the surgical plan; group 2 consisted of lesions that might delay or alter the surgical procedure.
  
  
  
  We identified 268 patients (169 female), of mean age 39.1 ± 10.8 years, mean baseline body weight 108.7 ± 6.1 kg and mean body mass index (BMI) 40.3 ± 6.1 kg/m2for analysis. Overall prevalence of abnormal OGD findings was 51.1 %, which included gastritis (32.5 %), hiatus hernia (17.9 %), duodenitis (8.6 %) and erosive oesophagitis (7.5 %); 27.2 % had group 2 lesions. Univariate analysis revealed older age (p = 0.016), use of NSAIDs (p = 0.004) and presence of reflux symptoms (p = 0.029) as significant risk factors of group 2 lesions. On multivariate analysis, use of NSAIDs (p = 0.015) and reflux symptoms (p = 0.039) remained significant predictive factors. In the low-risk subgroup (40 years and younger, without reflux symptoms or use of NSAIDs), the prevalence of group 2 abnormalities was 18.9 %.
  
  
  
  Significant endoscopic abnormalities are common among obese Chinese patients which may delay or change the surgical plan. The negative predictive value in low-risk patients was not strong. We therefore recommend routine preoperative endoscopy for all patients.
authors.affiliation: Prince of Wales Hospital, Sha Tin, Hong Kong, China. endersng@surgery.cuhk.edu.hk.
authors.forename: June
authors.initials: J
authors.lastname: Lee
authors.affiliation: Prince of Wales Hospital, Sha Tin, Hong Kong, China.
authors.forename: Simon Kin-Hung
authors.initials: SK
authors.lastname: Wong
authors.affiliation: Prince of Wales Hospital, Sha Tin, Hong Kong, China.
authors.forename: Shirley Yuk-Wah
authors.initials: SY
authors.lastname: Liu
authors.affiliation: Prince of Wales Hospital, Sha Tin, Hong Kong, China.
authors.forename: Enders Kwok-Wai
authors.initials: EK
authors.lastname: Ng
mesh_terms: D000293:Adolescent; D000328:Adult; D044466:Asian People; D050110:Bariatric Surgery; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011300:Preoperative Care; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
keywords: Bariatric surgery; Chinese; Preoperative OGD