J Chen, MD, R Patel, Y Zhai, MPH, A Trane, A Langell, E Morrow, MD, R Glasgow, MD, A Ibele, MD, E Volckmann, MD. University of Utah
Objective: The aim of this study was to evaluate the diagnostic yield of routine preoperative esophagogastroduodenoscopy (EGD) in patients undergoing bariatric surgery.
Background: Obesity is a potential risk factor for a number of chronic disease processes that impact the upper gastrointestinal tract. Reflux and heartburn are conditions frequently affecting obese patients, and are often related to a hiatal hernia (HH), the presence of which has important implications in the bariatric surgery patient. Despite this, the utility of routine preoperative EGD in patients undergoing bariatric surgery remains controversial.
Methods: Following institutional review board approval, the electronic medical records of patients who underwent bariatric surgery at a university hospital-based bariatric surgery program between August 2011 and July 2016 were retrospectively evaluated. Clinical history and preoperative EGD reports were reviewed for abnormal findings, which necessitated changes in medical management or alterations in surgical procedure.
Results: Three hundred and eighty nine patients were included in the study. Three hundred and forty five (88.6%) had preoperative EGDs performed. Half of all patients (n=173) were found to have a HH (Type I: n=161, 46.6%; Type II: 0.3%, n=1; Type III: 3.2%, n=11). Of these, 73% (n=127) had a history of heartburn, reflux or dysphagia. In all, 37% of patients (127/345) with a history of heartburn, reflux or dysphagia were found to have a HH. Thirty two percent (n=110) of patients were found to have gastritis, esophagitis or duodenitis. Ulcers were found in 7.2% (n=25) of patients. Of the patients who had preoperative EGDs, biopsies for Helicobacter (H) Pylori and Barrett's esophagus were taken in 46% (n=159) and 28% (n=98) respectively. H. Pylori was positive in 16.3% (n=23) and Barrett’s 3% (n=3). Forty percent of patients (n=138) were placed on anti-reflux medications following EGD. Surgical procedure was altered in 18.8% (n=65) of patients. Of all patients who underwent screening EGDs, 75% (n=258) had abnormal findings.
Conclusion: Preoperative EGD identifies a significant proportion of upper gastrointestinal pathologies in patients considering bariatric surgery. Abnormal findings may have important implications for medical management and surgical planning. Routine use of screening EGDs should be considered in all patients undergoing bariatric surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79662
Program Number: P523
Presentation Session: Poster (Non CME)
Presentation Type: Poster