title: Efficiency of preoperative esophagogastroduodenoscopy in identifying operable hiatal hernia for bariatric surgery patients.
abstract: BACKGROUND
  Gastroesophageal reflux (GERD) is a symptom frequently found in obese patients, and often is related to the presence of a hiatal hernia (HH). Surgeons may evaluate for the presence of HH on esophagogastroduodenoscopy (EGD). However, preoperative endoscopic presence or absence of a significant HH does not always correlate with intraoperative findings.
  
  
  OBJECTIVE
  To compare the rate of detection of repairable HH between clinical, endoscopic, and intraoperative methods SETTING: Independent, university-affiliated teaching hospital METHODS: A retrospective chart review of all consecutive patients who had undergone a primary bariatric procedure sleeve gastrectomy, gastric bypass, or biliopancreatic diversion/duodenal switch with routine preoperative EGD in a single institution from 2009-2013 was performed. Data points included the diagnosis of GERD/heartburn/proton pump inhibitor or histamine antagonist from history, the diagnosis of HH from preoperative EGD, and the diagnosis of HH intraoperatively that merited repair.
  
  
  RESULTS
  1570 consecutive patients were included in the study. Eight hundred fifty-seven (55%) had diagnosis of GERD or heartburn, and 713 (45%) were asymptomatic (negative for GERD or heartburn). Hiatal hernia repair was performed in 153 (18%) patients with the diagnosis of GERD or heartburn and in 107 (15%) patients without the diagnosis of GERD and or heartburn. In all, 434 (28%) out of 1570 patients had a finding of HH on EGD; 204 (47%) were repaired. On endoscopy, 326 (75%) were defined as small, 87 (20%) as moderate, and 21(5%) as large HH. Of these, repairs were done on 128 (39%), 60 (70%), and 16 (76%). The sensitivity of detecting repairable HH by clinical indicators such as GERD or heartburn was 55% (P = .123) and sensitivity of EGD findings was 78% (P = .000). Specificity was 46% and 82%, respectively.
  
  
  CONCLUSIONS
  Small HH are over-diagnosed with EGD, as most do not require repair. However, moderate and large HH are accurately detected.
authors.affiliation: 1200 Old York Road, Abington, Pennsylvania. Electronic address: Rmoham03@gmail.com.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Mohammed
authors.affiliation: 1200 Old York Road, Abington, Pennsylvania.
authors.forename: Patrick
authors.initials: P
authors.lastname: Fei
authors.affiliation: 1200 Old York Road, Abington, Pennsylvania.
authors.forename: John
authors.initials: J
authors.lastname: Phu
authors.affiliation: 1200 Old York Road, Abington, Pennsylvania.
authors.forename: Megumi
authors.initials: M
authors.lastname: Asai
authors.affiliation: 1200 Old York Road, Abington, Pennsylvania.
authors.forename: Gintaras
authors.initials: G
authors.lastname: Antanavicius
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000592:standards*; D005764:Gastroesophageal Reflux / Q000209:etiology; D006356:Heartburn / Q000209:etiology; D006551:Hernia, Hiatal / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D054328:Proton Pump Inhibitors
keywords: Bariatric surgery; Duodenal switch; Gastric bypass; Hiatal hernia; Vertical sleeve gastrectomy; esophagogastroduodenoscopy