Victoria C Chang, MD1, Ping Pan, MD1, Elizabeth Haberl, MD2, Charlie Wan2, Aditya Srinivasan2, Garth Davis, MD1, Shinil Shah, MD1, Tanyaradzwa M Kajese, MD1, John A Primomo, MD1. 1McGovern Medical School at the University of Texas Health Science Center at Houston, Department of Surgery, 2McGovern Medical School at the University of Texas Health Science Center at Houston
Introduction: The role of routine pre-operative endoscopy prior to primary weight loss surgery remains controversial. Multiple recent analyses suggest this not to be necessary. We sought to review our experience to determine the frequency of abnormal findings in patients undergoing routine pre-operative endoscopy prior to bariatric surgery.
Methods: A retrospective chart review was performed between July 2014 and June 2016 of patients undergoing routine pre-operative endoscopy prior to planned primary bariatric surgery. Variables evaluated included pre-operative symptoms, planned bariatric surgical procedure, abnormal findings on endoscopy, and changes in planned bariatric surgical procedure after pre-operative endoscopy. Patients were analyzed based on their initial choice of weight loss surgery. Analysis was performed using Pearson’s Chi-squared test or Fisher’s exact test (categorical data).
Results: A total of 631 patients met inclusion criteria. There were 457 females (72%) and 174 males (28%). The median age was 44 (IQR 36 to 55). The median BMI was 46 (IQR 42 to 51). Data is presented in Table 1. Amongst the entire cohort, the majority of patients had no pre-endoscopy clinical symptoms (61.3%). The most frequent abnormal findings included esophagitis (26.5%), hiatal hernia (27.1%), gastric ulcer (4.9%), and biopsy proven Barrett’s esophagus (4.6%). 14.6% of patients had a change in their planned operation after endoscopy results. Frequency of abnormal findings did not differ based on pre-operative symptoms (asymptomatic versus symptomatic) amongst patients who initially chose sleeve gastrectomy or gastric bypass.
Conclusion: Our large series demonstrates several important findings. The frequency of abnormal endoscopy findings, particularly esophagitis and Barrett’s esophagus, appears to be independent of pre-endoscopy symptoms. Endoscopic findings led to a change in planned procedure in nearly 15% of patients. These findings suggest that lack of routine pre-operative endoscopy or selective screening in symptomatic patients only may lead to failure of discovery of foregut pathology that should prompt consideration for changes in the planned bariatric surgical procedure. Further study is necessary to see if our findings have broad applicability.
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Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93268
Program Number: S065
Presentation Session: Residents and Fellows Session
Presentation Type: ResFel