Background
Roux-en-Y gastric bypass is the most frequent bariatric operation. In this operation, the distal bypassed stomach is left in situ. We studied preoperative clinical, endoscopic and histologic findings in a consecutive group of morbidly obese patients prior to bariatric surgery.
Methods
A prospective study was conducted from August 1999 until May 2004, which consisted of 426 patients with morbid obesity. There were 94 men and 332 women, with mean age 39.5 years. In all patients prior to surgery, upper endoscopy was performed and biopsy samples were taken distal to squamo-columnar junction (cardiac biopsies), and in 232 of them also in at the antrum.
Results
Pathological findings at the esophagus were seen in 55% of the patients, mainly related to reflux esophagitis. Barrett’s esophagus was seen in 5.8%. In the stomach, pathological findings were seen in 32% of the patients. Active peptic ulcer was demonstrated in 2.6% of the cases. At the duodenum, pathologic findings were detected in 13.4% of the patients, showing an ulcer in 2.6%. At the stomach, chronic inactive gastritis and atrophic gastritis with intestinal metaplasia were found in 8.6% and 6.5% respectively. Antral adenoma with low-grade dysplasia was found in 1 patient, and 1 carcinoid tumor. H. pylori was present in 53% of the patients, mainly in the antrum.
Conclusion
In candidates for bariatric surgery, upper endoscopy with biopsy samples and determination of H. pylori should be routinely performed. If present, H. pylorishould be eradicated. After surgery, if Barrett’s esophagus was present, endoscopic surveillance is recommended.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Sundbom M, Nyman R, Hedenström H et al. Investigation of the excluded stomach after Roux-en-Y gastric bypass. Obes Surg 2001; 11: 25–7.
Silecchia G, Catalano C, Gentileschi P et al. Virtual gastroduodenoscopy: a new look at the bypassed stomach and duodenum after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2002; 12: 39–48.
Monnier P, Savary M. Contribution of endoscopy to gastro- esophageal reflux disease. Scand J Gastroenterol 1984; 19 (Suppl 106): 26.
Hill LD, Kozarek RA, Kraemer SFM et al. The gastroesophageal flop valve: in vitro and in vivo observations. Gastrointest Endosc 1996; 44: 541–7.
Dixon MF, Genta RM, Yardley JH et al. Classification and grading of gastritis. The Updated Sydney System. Am J Surg Path 1996; 10: 1161–81.
Yamada T, Takasu Y. Symposium: The elevated lesions of the stomach. “Polipoid lesions” of the stomach. Gastroenterol Jap 1967; 2: 305–10.
Verset D, Houben JJ, Gay F et al. The place of upper gastrointestinal tract endoscopy before and after vertical banded gastroplasty for morbid obesity. Dig Dis Sci 1997; 42: 2333–7.
Frigg A, Peterli R, Zynamon A et al. Radiologic and endoscopic evaluation for laparoscopic adjustable gastric banding: preoperative and follow-up. Obes Surg 2001; 11: 594–9.
Schirmer B, Erenaglu C, Miller A. Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. Obes Surg 2002; 12: 634–8.
Sharaf RN, Weinshel EH, Binin EJ et al. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg 2004; 14: 1367–72.
Madan AK, Speck KE, Miler ML. Routine preoperative upper endoscopy for laparoscopic gastric bypass. Is it necessary? Am Surg 2004; 70: 684–6.
Zeni TM, Frantzides CT, Mahr C et al. Value of preoperative upper endoscopy in patients undergoing gastric bypass. Obes Surg 2006; 16: 142–6.
Ghamessian AJ, MacDonald KG, Cunninghan PG et al. The workup for bariatric surgery does not require a routine upper gastrointestinal series. Obes Surg 1997; 7: 16–8.
Frezza EE, Ikramuddin S, Gourash W et al. Symptomatic improvement in gastroesohageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc 2002; 16: 1027–31.
Csendes A. Burdiles P, Braghetto I et al. Early and late results of the acid suppression and duodenal diversion operation in patients with Barrett’s esophagus. Analysis of 210 cases. World J Surg 2002; 26: 566–75.
Hedberg J, Hedenström H, Nilsson S et al. Role of gastric acid in stomal ulcer after gastric bypass. Obes Surg 2005; 15: 1375–8.
Effect of gastric bypass on gastroesophageal reflux and erosive esophagitis in patients with morbid obesity. Rev Méd Chile 2006; 134: 285–90.
Renshaw AA, Rabaza JR, Gonzalez AM et al. Helicobacter pylori infection in patients undergoing gastric bypass surgery for morbid obesity. Obes Surg 2001; 11: 281–3.
Flickinger EG, Sinar DR, Pories WJ et al. The bypassed stomach. Am J Surg 1985; 149: 151–6.
Sundbom M, Medernstion H, Gustafsson S. Duodenogastric bile reflux after gastric bypass. A cholecinstigraph study. Dig Dis Sci 2004; 47: 1891–6.
Escalona A, Guzmán S, Ibáñez L et al. Gastric cancer after Roux-en-Y gastric bypass. Obes Surg 2005; 15: 423–7.
Corsini DA, Simoneti SA, Moreira G et al. Cancer in the excluded stomach 4 years after gastric bypass. Obes Surg 2006; 16: 932–4.
De Roover A, Detry O, De Leval L et al. Report of two cases of gastric cancer after bariatric surgery: Lymphoma of the bypassed stomach after Roux-en-Y gastric bypass and gastrointestinal stromal tumor (GIST) after vertical banded gastroplasty. Obes Surg 2006; 16: 928–32.
Babor R, Booth M. Adenocarcinoma of the gastric pouch 26 years after loop gastric bypass. Obes Surg 2006; 16: 935–9.
De Roover A, Detry O, Desaive C et al. Risk of upper gastrointestinal cancer after bariatric operations. Obes Surg 2006; 16: 1656–61.
Csendes A, Burdiles P, Papapietro K et al. Results of gastric bypass plus resection of the distal excluded gastric segment in patients with morbid obesity. J Gastrointest Surg 2005; 9: 121–31.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Csendes, A., Burgos, A.M., Smok, G. et al. Endoscopic and Histologic Findings of the Foregut in 426 Patients with Morbid Obesity. OBES SURG 17, 28–34 (2007). https://doi.org/10.1007/s11695-007-9002-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-007-9002-9