Main Article Content
Abstract
Background:
Routine esophagogastroduodenoscopy (EGD) before bariatric surgery remains controversial. This study was undertaken to determine the feasibility, safety, and effectiveness of routine intraoperative esophagogastroduodenoscopy (EGD) before bariatric surgery, the incidence of pathological EGD findings in patients undergoing bariatric surgery, the incidence of altered surgical plans because of the EGD findings, and to correlate patient symptoms with the EGD findings.
Methods:
This is a Prospective ongoing, interventional study that was started on March 1st, 2018 with this preliminary report covering the cases up to September 30th, 2019. Routine intraoperative pre-bariatric procedure EGD was done and findings recorded. Patients consented for the endoscopy and the possibility of altering the planned operation was discussed with the patient.
Results:
Routine intraoperative EGD was done on 1727 patients. Nine hundred twenty-two (53.4%) were female. Three hundred fifty-one (20.3%) patients had preoperative history of or symptoms of gastroesophageal reflux disease out of which 84(29%) had positive findings on endoscopy. One hundred twenty (6.9%) had esophagitis and only 22(18.3%) had symptoms of gastroesophageal reflux disease (GERD) preoperatively. Two hundred ninety (16.7%) had gastritis, 392(22.3%) had bile in stomach, 105(6.07%) had duodenitis and 50 (2.9%) had a hiatus hernia. Our primary plan of surgery was changed based on endoscopic findings in 47(2.7%) of patients.
Conclusion:
Intraoperative EGD is do-able, cost-effective, safe and convenient for both the patient and surgeon. We found asymptomatic significant upper gastrointestinal (UGI) pathologies that altered the planned procedure in 2.7% of the patients.
Keywords
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References
- Gerson LB. Impact of obesity on endoscopy. Gastrointest Endosc. 2009 Oct;70(4):758-62.
- Sharaf RN, Weinshel EH, Bini EJ, Rosenberg J, Sherman A, Ren CJ. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg. 2004 Dec;14(10):1367-72.
- Munoz R, Ibanez L, Salinas J, Escalona A, Perez G, Pimentel F, et al. Importance of routine preoperative upper GI endoscopy: why all patients should be evaluated? Obes Surg. 2009 Apr;19(4):427-31.
- Csendes A, Burgos AM, Smok G, Beltran M. Endoscopic and histologic findings of the foregut in 426 patients with morbid obesity. Obes Surg. 2007 Jan;17(1):28-34.
- De Moura Almeida A, Cotrim HP, Santos AS, Bitencourt AGV, Barbosa DBV, Lobo AP, et al. Preoperative upper gastrointestinal endoscopy in obese patients undergoing bariatric surgery: is it necessary? Surg Obes Relat Dis. 2008 Apr;4(2):144-9.
- Arrowsmith JB, Gerstman BB, Fleischer DE, Benjamin SB. Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc. 1991 Aug;37(4):421-7.
- Anderson MA, Gan SI, Fanelli RD, Baron TH, Banerjee S, Cash BD, et al. Role of endoscopy in the bariatric surgery patient. Gastrointest Endosc. 2008 Jul 1;68(1):1-10.
- Sauerland S, Angrisani L, Belachew M, Chevallier JM, Favretti F, Finer N, et al. Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2005 Feb;19(2):200–21.
- Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obes Silver Spring Md. 2009 Apr;17 (1): S1-70, v.
- Evans JA, Muthusamy VR, Acosta RD, Bruining DH, Chandrasekhara V, Chathadi KV, et al. The role of endoscopy in the bariatric surgery patient. Surg Obes Relat Dis. 2015 May 1;11(3):507–17.
- Azagury D, Dumonceau J, Morel P, Chassot G and Huber O. Preoperative work up in Asymptomatic Patients Undergoing Roux-en-Y Gastric Bypass: Is Endoscopy Mandatory? Obes Surg. 2006; 16(10): 1304-11.
- Wiltberger G, Bucher JN, Schmelzle M, Hoffmeister A and Dietrich A. Preoperative endoscopy and its impact on perioperative management in bariatric surgery. Dig Surg. 2015;32(4):238-42.
- Csendes A, Burgos AM, Smok G, Beltran M. Endoscopic and Histologic Findings of the Foregutin 426 pattients with morbid obesity. Obes Surg. 2007 Jan;17(1):28-34.
References
Gerson LB. Impact of obesity on endoscopy. Gastrointest Endosc. 2009 Oct;70(4):758-62.
Sharaf RN, Weinshel EH, Bini EJ, Rosenberg J, Sherman A, Ren CJ. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg. 2004 Dec;14(10):1367-72.
Munoz R, Ibanez L, Salinas J, Escalona A, Perez G, Pimentel F, et al. Importance of routine preoperative upper GI endoscopy: why all patients should be evaluated? Obes Surg. 2009 Apr;19(4):427-31.
Csendes A, Burgos AM, Smok G, Beltran M. Endoscopic and histologic findings of the foregut in 426 patients with morbid obesity. Obes Surg. 2007 Jan;17(1):28-34.
De Moura Almeida A, Cotrim HP, Santos AS, Bitencourt AGV, Barbosa DBV, Lobo AP, et al. Preoperative upper gastrointestinal endoscopy in obese patients undergoing bariatric surgery: is it necessary? Surg Obes Relat Dis. 2008 Apr;4(2):144-9.
Arrowsmith JB, Gerstman BB, Fleischer DE, Benjamin SB. Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc. 1991 Aug;37(4):421-7.
Anderson MA, Gan SI, Fanelli RD, Baron TH, Banerjee S, Cash BD, et al. Role of endoscopy in the bariatric surgery patient. Gastrointest Endosc. 2008 Jul 1;68(1):1-10.
Sauerland S, Angrisani L, Belachew M, Chevallier JM, Favretti F, Finer N, et al. Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2005 Feb;19(2):200–21.
Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obes Silver Spring Md. 2009 Apr;17 (1): S1-70, v.
Evans JA, Muthusamy VR, Acosta RD, Bruining DH, Chandrasekhara V, Chathadi KV, et al. The role of endoscopy in the bariatric surgery patient. Surg Obes Relat Dis. 2015 May 1;11(3):507–17.
Azagury D, Dumonceau J, Morel P, Chassot G and Huber O. Preoperative work up in Asymptomatic Patients Undergoing Roux-en-Y Gastric Bypass: Is Endoscopy Mandatory? Obes Surg. 2006; 16(10): 1304-11.
Wiltberger G, Bucher JN, Schmelzle M, Hoffmeister A and Dietrich A. Preoperative endoscopy and its impact on perioperative management in bariatric surgery. Dig Surg. 2015;32(4):238-42.
Csendes A, Burgos AM, Smok G, Beltran M. Endoscopic and Histologic Findings of the Foregutin 426 pattients with morbid obesity. Obes Surg. 2007 Jan;17(1):28-34.