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Endoscopists and Surgeons Playing in the Same Team: The Multidisciplinary Approach in Screening and Preoperative Workup

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Bariatric Therapy

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Abstract

In the multidisciplinary approach of a patient seeking surgical help for severe obesity, a multidisciplinary team is often involved and other specialities such as a pulmonologist and a cardiologist are called up when needed. In this row, the interventional radiologist, the gastroenterologist and the endoscopist figure as a second-hand assist. Some advocate endoscopists to be part of the multidisciplinary team already from the onset. Several guidelines define the minimum requirements of preoperative workup, but leave the decision of a preoperative endoscopy and gastrointestinal workup to the surgeon, i.e. only in patients with clinically significant gastrointestinal symptoms. However, obesity is associated with oesophageal motility disturbances and with gastro-oesophageal reflux-promoting circumstances. These conditions are often asymptomatic in the obese preoperatively and may become symptomatic after certain types of surgery. Moreover, when gastro-oesophageal symptoms resolve after an operation, this does not necessarily signify an improvement because the development of Barrett’s epithelium as an adaptation to acid reflux may obscure this premalignant and adverse complication of gastro-oesophageal reflux disease. The fear of missing a cancer is not a real problem in low-incidence areas and as such not a true indication for a preoperative endoscopy but this may be different in Asian countries. The two meta-analyses that investigated changes in the choice of the procedure based on endoscopic findings concluded that routine endoscopy is not indicated and that patient’s symptoms, risk factors and type of procedure planned should be the leading factors, but as stated earlier you can win a lot of haggling. Another controversy is the need of preoperative weight loss, often required by insurance companies, but here surgeons and gastroenterologists should navigate on their personal experience, the type and degree of obese referrals, and the volume of operations already having performed.

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Abbreviations

AACE:

American Association of Clinical Endocrinologists

ASA:

American Society of Anaesthesiologists

ASGE:

American Society for Gastrointestinal Endoscopy

ASMBS:

American Society for Metabolic and Bariatric Surgery

BMI:

Body mass index

C. difficile :

Clostridium difficile

CAGS:

Canadian Association of General Surgeons

CDAI:

Crohn’s Disease Activity Index

CT:

Computed tomography

EAES:

European Association of Endoscopic Surgery

EASO:

European Association for the study of Obesity

FES:

Fundamentals of endoscopic surgery

FLS:

Fundamentals of laparoscopic surgery

GI:

Gastrointestinal

GIST:

Gastrointestinal stromal tumour

GORD:

Gastro-oesophageal reflux disease

H. pylori :

Helicobacter pylori

Hp :

Helicobacter pylori

IBD:

Inflammatory bowel disease

IFSO-EC:

International Federation for the Surgery of Obesity-European Chapter

IGB:

Intragastric balloons

IL:

Interleukin

LAGB:

Laparoscopic adjustable gastric banding

LOS:

Length of stay

LOS:

Lower oesophageal sphincter

LOSP:

Lower oesophageal sphincter pressure

MALT:

Mucosa-associated lymphoid tissue

MRI:

Magnetic resonance imaging

NIH:

National Institutes of Health

NSAID:

Non-steroidal anti-inflammatory drug

OGD:

Oesophagogastroduodenoscopy

OR:

Odds ratio

PPI:

Proton pump inhibitor

RCT:

Randomised controlled trial

RYGB:

Roux-en-Y gastric bypass

SAGES:

Society of American Gastrointestinal and Endoscopic Surgeons

SG:

Sleeve gastrectomy

SOReg:

Scandinavian Obesity Register

TLOSR:

Transient LOS relaxation

TNF-α:

Tumour necrosis factor-alpha

TOS:

The Obesity Society

VBG:

Vertical banded gastroplasty

VLCD:

Very-low-calorie diets

VLED:

Very-low-energy diets

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  1. Amsterdam UMC (University Medical Centres), Amsterdam, The Netherlands

    Elisabeth M. H. Mathus-Vliegen

  2. Polyclinique Lyon Nord, Lyon, France

    Jérôme Dargent

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Mathus-Vliegen, E.M.H., Dargent, J. (2018). Endoscopists and Surgeons Playing in the Same Team: The Multidisciplinary Approach in Screening and Preoperative Workup. In: Bariatric Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-90074-2_4

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