Preoperative endoscopy in bariatric patients may change surgical strategy

Francisco Schlottmann, Romina Reino, Marina Spano, Martin Galvarini, Jose Alvarez Gallesio, Rudolf Buxhoeveden. Hospital Aleman of Buenos Aires

Introduction: While esophagogastroduodenoscopy (EGD) is mandatory prior to any gastric surgery, many centers considered it unnecessary before bariatric surgery. However, because sleeve gastrectomy (SG) could negatively impact on gastroesophageal reflux disease (GERD), endoscopic findings could change the strategy to a Roux -en- Y gastric bypass (RYGB), which is considered the gold standard for treatment the obese patient with GERD. The aim of this study was to evaluate the utility of the EGD before bariatric surgery.

Methods and procedures:  A retrospective study based on a prospectively loaded database was performed. A consecutive series of bariatric surgery candidates with preoperative EGD were included. The sample was divided into two groups according to the presence or absence of GERD like symptoms before surgery. G1: patients without symptoms and G2: patients with symptoms. Abnormal EGD findings were defined as presence of hiatal hernia, esophagitis and / or Barrett's esophagus.

Results: Between 2008 and 2015, a total of 193 patients were included; 123 (63.7 %) patients were female. Mean age was 46 (18-71) years. Mean preoperative BMI was 44.5 kg/m2 (31-96). Distribution among groups was as follows: G1, 136 patients (70 %), and G2, 57 patients (30%). Abnormal findings consistent with GERD were found in 40 patients (29.4 %) in G1 and in 30 patients (52.6 %) in G2.  Gastric bypass was performed in 90% of patients with abnormal EGD in G1 and in 80% of patients in G2 patients with abnormal EGD.

Conclusions: EGD should be requested as a routine preoperative study in patients undergoing bariatric surgery because its findings could change the surgical strategy