Trans Nasal Endoscopy As an Office Procedure for Bariatric Surgery Evaluation

Helmuth T Billy, MD. Ventura Advanced Surgical Associates

Introduction:  Preoperative and postoperative evaluation of bariatric surgery patients often requires the use of fiberoptic endoscopy to preoperatively screen patients or evauate for possible complications.  Trans nasal endoscopy offers the potential to streamline evaluation of patients and decrease the costs associated with evaluating these patients.

Methods and Procedure:  15 bariatric surgery patients were evaluated for preoperative pathology and postoperative complications in an office setting using trans nasal endoscopy.  No sedation was required.  Preparation of the nasal passage was accomplished using Afrin nasal decongestant and  4% lidocaine spray.  The endoscope was advanced into either the right or left nasal passage and advanced along the floor of the nares until the soft palate was visualized.  The endoscope was advanced to the pharynx and then each subject swallowed a small sip of water and the scope was easily passed into the esophagus.  Endoscopic evaluation of the proximal, mid and distal esophagus was accomplished.  The GE junction was evaluated for any evidence of Barretts esophagus.  In all patients the stomach or the gastric pouch was examined, retroflexed visualization of the GE junction was perfromed and if indicated biopsies to rule out H. Pylori was performed. 

The average procedure length was 11minutes 45 seconds.  All patients were discharged within a few minutes of their procedure.  All patients were able to drive themselves following the procedure.  

No complications occurred.  Patient satisfaction surveys were completed.  Each patient felt the technology was superior to having to undergo sedation or a prolonged investment in time which would have occurred with traditional fiiberoptic endoscopy.  All patients studied would reccomend the procedure to a friend.  All the procedures were completed without early termination.  

Results:  15 patients were studied.  Two hiatal hernias were identified.  One eroded lap band was discovered.  One marginal ulcer was discovered.  Seven patients were biopsied for H.Pylori.  No complications were reported. 

Conclusion: Trans nasal endoscopy appears to be easily integrated into a bariatric office setting as a practical procedure for ensocopic screening of potential bariatric surgery patients.  Evaluation of postoperative patients allowed successful visualization of Lap band anatomy and gastric bypass pouch and anastomosis.