Michael Nicoara, DO, Nicholas Morin, DO, Shinban Liu, DO, Corneliu Vulpe, MD, George Ferzli, MD. NYU Langone Brooklyn
Introduction: There is still controversy regarding whether or not a preoperative esophagogastroduodenoscopy (EGD) should be done before bariatric surgery; does it change surgical course, and does it prevent postoperative complications? Here we present a relevant case and review the current literature relating to preoperative EGDs in bariatric surgery.
Case Presentation: A 51 year female presents for preoperative workup prior to undergoing a restrictive bariatric procedure. A standard institutional preoperative workup was performed without an EGD. Patient returned postoperative day number two with hematemesis. Emergent EGD showed clotted blood in the stomach and a Dieulafoy ulcer that was successfully clipped by the endoscopist.
Methods: A literature review was performed using Pubmed. Search term “EGD bariatric surgery” was used.
Results: PubMed search returned 50 papers, and 13 were selected for review due to their relevance; 4 against EGD, 5 in favor of EGD, and 4 in favor if patient has reflux symptoms.
Discussion: A Dieulafoy ulcer is rare, accounting for 1-2% of upper gastrointestinal bleeding presentations. Our patient presented with classic findings of this lesion: larger diameter vessel on the lesser curve of the stomach, about 6 cm from the gastroesophageal junction, with vessel protruding through a mucosal defect with active arterial bleeding. It is uncertain if a preoperative EGD would have located this lesions and/or provided a means for intervention before presentation. Our literature review on the subject shows that preoperative EGD rarely changes surgical management. They do change medical management in a significant number of cases. With the majority of papers in favor of preoperative EGD (albeit 4 only if patient has symptoms of GERD) there is evidence in favor of performing a preoperative EGD before bariatric surgery.
Conclusion: The current literature is equivocal regarding a preoperative EGD as it rarely changes the surgical management, but often changes the medical management. Even though the yield is small, we recommend preoperative EGD before bariatric procedures for medical optimization; in order to avoid the potentially devastating consequences associated with a missed lesions such as the one presented.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92117
Program Number: P050
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster