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Preoperative Endoscopic and Radiologic Evaluation of Bariatric Patients: What Do They Add?

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Preoperative esophagogastroduodenoscopy (EGD) and barium swallow (BS) are commonly performed for evaluation in bariatric surgery patients. The routine use of these modalities has been controversial.

Methods

A retrospective review of a prospectively maintained database was performed to include primary bariatric surgery patients between March 2013 and August 2016.

Results

Two hundred nine patients were included. All the patients underwent preoperative EGD and BS. The mean age was 43.12 years and BMI 46.4 kg/m2. Reflux symptoms were present in 58.5% of patients. Preoperative EGD revealed abnormalities in 87.5% of patients: esophagitis (54.5%), Barrett’s esophagus (5.3%), dysplasia (1%), and gastritis (51%). Endoscopic evidence of HH was documented in 52.2% of patients while only 34% of patients had evidence of HH in their BS. Of the asymptomatic patients, 80.2% had abnormal EGD. Helicobacter pylori on biopsy was found in 17.2% patients, out of which 47.2% were asymptomatic. Based on EGD findings, the choice of surgical procedure was changed in 3.34% of patients. Repair of HH was performed in 107 patients, with 68.2% (n = 73) symptomatic patients and 31.8% (n = 34) asymptomatic patients. On ROC analysis, EGD was better predictive of the presence of HH (AUC = 0.802, OR 5.20, p  =   < 0.0001) and symptoms were a poor indicator for GERD.

Conclusions

Preoperative EGD is abnormal in the majority of patients regardless of their symptoms. EGD is the only modality that can provide tissue sample, which can potentially determine the type of bariatric surgery. Given the low diagnostic accuracy of BS, its routine use can be eliminated.

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Authors and Affiliations

  1. Department of Surgery, Banner- University Medical Center, University of Arizona, 1501 N. Campbell Avenue, PO Box 245066, Tucson, AZ, 85724, USA

    Iman Ghaderi, Amlish B. Gondal & Julia Samamé

  2. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Federico Serrot

  3. Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Carlos A. Galvani

Authors
  1. Iman Ghaderi
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  2. Amlish B. Gondal
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  3. Julia Samamé
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  4. Federico Serrot
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  5. Carlos A. Galvani
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Contributions

IG: Study conception, design, analysis, and drafting of the manuscript

ABG: data analysis, literature review, critical analysis, and review of the manuscript

JS: data collection and analysis, manuscript review

FS: data collection and manuscript review

CG: data interpretation, revision, and critical review of the manuscript

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Correspondence to Iman Ghaderi.

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The authors declare that they have no conflict of interest.

Institutional Review Board Approval

This study is based on a bariatric database approved by the University of Arizona IRB (protocol approval number: 10-0744-01).

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Table 7 The choice of surgical procedure was changed as
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Ghaderi, I., Gondal, A.B., Samamé, J. et al. Preoperative Endoscopic and Radiologic Evaluation of Bariatric Patients: What Do They Add?. J Gastrointest Surg 24, 764–771 (2020). https://doi.org/10.1007/s11605-019-04219-8

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  • DOI: https://doi.org/10.1007/s11605-019-04219-8

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