Routine Preoperative Esophagogastroduodenoscopy in Patients Undergoing Bariatric Surgery

Umer I Chaudhry, MD, Dean J Mikami, MD, Bradley J Needleman, MD, W. Scott Melvin, MD, Sabrena F Noria, MD. The Ohio State University Wexner Medical Center.

INTRODUCTION- Bariatric surgery is now accepted as the most effective treatment for morbid obesity. However, given the various surgical options (ie: RYGB, sleeve gastrectomy, gastric band), and ensuing changes in the GI tract, it is imperative that bariatric surgeons suggest the appropriate procedure for the appropriate patient. Use of selective versus routine esophagogastroduodenoscopy (EGD) in the preoperative workup of bariatric surgery patients remains controversial. We hypothesized that routine preoperative EGD is necessary for complete work-up of a patient in order to perform the appropriate surgery.

METHODS AND PROCEDURES- Preoperative bariatric surgery patients who had undergone routine EGD between February 2013 and September 2013 were analyzed retrospectively. EGD findings and pathology results were reviewed.

RESULTS- Twenty-five patients with GERD related symptoms and 25 asymptomatic patients were included in the final analysis. Mean age was 42.1 (range: 22-60) and 43.9 (range: 20-59) and mean BMI was 53.0 (range: 38.0-84.9) and 52.6 (range: 37.8-84.4) for asymptomatic and symptomatic patients, respectively. Females accounted for 80% of the patients in the asymptomatic group versus 68% in the symptomatic cohort. The most common findings in the symptomatic group were gastritis (n=9; 36%), hiatal hernia (n=5; 20%), gastric polyps (n=5; 20%), and esophagitis (n=5; 20%). One patient (4%) was positive for H. pylori and 1 patient (4%) had non-dysplatic Barrett’s esophagus. One individual (4%) was found to have a grade 1 neuroendocrine tumor of the duodenum. In the asymptomatic cohort, the most common findings were hiatal hernia (n=8; 32%), gastritis (n=7; 28%), gastric polyps (n=2; 8%), gastric ulcers (n=2; 8%), and esophagitis (n=2; 8%). Two patients (8%) were found positive for H. pylori. Fifty-percent (n=6) of asymptomatic patients desiring sleeve gastrectomy were found to have hiatal hernia.

CONCLUSIONS- Asymptomatic morbidly obese patients have similar GI pathology as symptomatic patients. Given this similarity, and the consequences of untreated (H. pylori) or missed pathology (gastric/duodenal polyps) routine EGD should be included as part of the pre-operative work-up of bariatric patients.

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