Does Preoperative Endoscopy in Bariatric Surgery Alter the Medical or Surgical Strategy?

Introduction: Controversy exists as to the need for preoperative esophago-gastro-duodenoscopy (EGD) for patients undergoing bariatric surgery. Specifically, do findings alter the medical and surgical management. The purpose of this study is to evaluate the role of preoperative EGD in the therapeutic strategy of bariatric surgery.

Methods: We conducted a retrospective analysis of consecutive patients undergoing bariatric surgery over an 18 month period (2006-2008). A total of 69 patients were reviewed and all patients underwent preoperative EGD prior to surgery.

Results: 14/69 patients underwent primary procedures (laparoscopic sleeve gastrectomy (LSG) or roux-en-y gastric bypass (LRYGB)) and 55/69 underwent a revision of a previous bariatric surgery to LSG or LRYGB. The findings included biopsy-proven H Pylori presence in 4 (2.7%), gastritis in 18 (12.4%), esophagitis in 14 (9.6%), hiatal hernias in 12 (8.2%), gastric polyps in 7 (4.8%), duodenal polyp in 2 (1.3%), and a duodenal lieomyoma in one patient (0.69%). 25 patients (17.2%) had no clinico-pathological findings. 11/55 (20.0%) of the patients that had previous bariatric procedures were found to have eroded bands on preoperative EGD. 8/11 bands were removed endoscopically and 3/11 were removed surgically. Preoperative endoscopy resulted in change in management in 16/69 patients (23.1%); 7/16 patients were from the primary bariatric group and 9/16 from the revisional group. Of the 7 primary group patients, 4 required H pylori treatment preoperatively, 2 required concurrent hiatal hernia repair, and 1 patient with duodenal lieomyoma underwent LSG instead of the planned LRYGB to allow surveillance. In the revision group, the operative strategy was changed from LRYGB to LSG following preoperative endoscopy in 6/9 patients. The operative strategy was changed to trans-gastric/laparoscopic in the 3 patients that required surgical removal of eroded bands.

Conclusion: Surgical strategies are significantly more affected by preoperative EGD in revisional bariatric cases as compared to primary bariatric procedures. Regardless, preoperative EGD is essential in both primary and revisional bariatric surgery since the management is altered in a large proportion of cases.

Session: Podium Presentation

Program Number: S105