title: Upper Gastrointestinal Endoscopy prior to Bariatric Surgery-Mandatory or Expendable? An Analysis of 801 Cases.
abstract: Upper gastrointestinal pathologies are common in bariatric patients. Preoperative esophagogastroduodenal endoscopy (EGD) should detect and treat pathologies that might alter the type of bariatric surgery. However, clinical consequences of these findings are often insignificant. The aim of this study was to assess the influence of preoperative endoscopy in our cohort and its clinical consequences.
  
  
  
  We conducted a retrospective analysis of endoscopic findings in patients under evaluation for bariatric surgery. Endoscopic findings were compared to preoperative risk factors as well as postoperative complications, and its clinical consequences were analyzed.
  
  
  
  Data was available for 801 patients. Abnormal endoscopic findings were found in 65.7% of all patients. The most common conditions were gastritis (32.1%) and gastroesophageal reflux (24.8%). Malignancies were observed in 0.5% of all patients. We observed early-stage adenocarcinoma of the esophagus in two patients through our routine preoperative evaluation. Helicobacter pylori infections were detected in preoperative biopsies in only 3.7% of all patients. Patients who reported reflux symptoms had a higher rate of pathological EGDs (74.2 vs. 64.9%, p .019). We did not find any other risk factors for a pathological endoscopy. The postoperative complication rate was 11.2%. Leakage rate was 1.1%. Mortality rate was 0.4%. We did not find any correlation between the incidence of postoperative complications and preoperative endoscopic findings.
  
  
  
  Relevant findings in routine preoperative endoscopy are rare but have significant influence on decision-making in bariatric patients and should be assessed as a necessary diagnostic tool.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. swolter@uke.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wolter
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Duprée
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Jameel
authors.initials: J
authors.lastname: Miro
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Schroeder
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Marie-Isabelle
authors.initials: MI
authors.lastname: Jansen
authors.affiliation: Department of Endocrinology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Clarissa
authors.initials: C
authors.lastname: Schulze-Zur-Wiesch
authors.affiliation: Department of Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Groth
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Jakob
authors.initials: J
authors.lastname: Izbicki
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Mann
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Busch
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D000328:Adult; D050110:Bariatric Surgery; D016099:Endoscopy, Gastrointestinal / Q000379:methods* / Q000706:statistics & numerical data*; D004938:Esophageal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005756:Gastritis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Bariatric surgery; Esophagogastroduodenoscopy; Gastric bypass; Obesity; Preoperative evaluation; Sleeve gastrectomy; Upper endoscopy