Preoperative Flexible Upper Endoscopy and Its Validity in Bariatric Surgery in a VA Population

David D O’Mara, Nikeeta Wilson, PAC, Juanita A Thomas, MSN, RN, Michelle K Savu, MD, FACS. Audie L. Murphy VA Hospital, STVHCS

Objective/Background:

Bariatric surgery is one of the most frequently performed general surgical procedures in the US although its performance is limited within the VA system. There is however some debate as to whether routine preoperative flexible upper endoscopy (FUE) is necessary in the evaluation of the bariatric surgery patient. We examined the findings of preoperative FUE in a VA bariatric surgery patient population to better determine the validity of its routine use in this population.

Methods:

This is retrospective study of prospective data collected in the bariatric surgery patient population using a computerized patient medical record data-base (CPRS) in the South Texas VA system between December 2012 until September 2014. All patients received routine preoperative FUE evaluation and then proceeded to have a bariatric surgery procedure, either laparoscopic gastric sleeve or bypass. The FUE and surgery were performed by a single surgeon provider. Means are expressed +/- standard deviation.

Results:

A total of 31 bariatric surgery patients underwent preoperative FUE at the South Texas VAHCS. There were 17 males and 14 female patients. Average age of patients was 45 years old (age range 27- 61) exhibiting a preoperative mean BMI of 42.4 +/- 5 kg/m2 (n = 31). Postoperatively the mean BMI decreased to 32.6 +/- 3 at 3 months ( n= 17); and 30.6 +/- 3 at 6 months ( n=14). Out of the 31 patients, 35% had positive findings on FUE delineated in Table 1. The results of the FUE changed the intended surgical intervention in 2/31 patients ( 6%).

Table 1

Pathology Individuals (%)
H. pylori 4/31(13%)
Gastritis 1/31 (3%)
Intestinal Metaplasia(Barretts) 2/31 (6%)
Gastric Ulcer 2/31(6%)
Gastric Stromal Tumor 1/31 (3%)
Hiatal Hernia 1/31 (3%)

Conclusion:

In our VA patient population, preoperative flexible upper endoscopy revealed pathology in 35% of patients, all of which required treatment (either preoperative medical or surgical treatment). Furthermore, several patients had significant pathology, which impacted the choice of surgical procedure. Therefore we conclude, in the VA population, routine preoperative upper endoscopic is a useful and valid procedure and should be performed on all patients undergoing bariatric surgery.

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