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Is Preoperative Upper Gastrointestinal Endoscopy in Obese Patients Undergoing Bariatric Surgery Mandatory? An Asian Perspective

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Abstract

Background

The role of routine preoperative oesopha gogastroduodenoscopy (OGD) for all bariatric surgery candidates is controversial. We aim to investigate the prevalence of clinically significant OGD findings in a primarily Chinese obese population and identify factors that predict a normal screening OGD.

Methods

Medical records of patients who underwent primary bariatric surgery in our centre from August 2002 to December 2014 were reviewed. OGD findings were classified into two groups: group 1 consisted of normal findings and abnormal findings that would not alter the surgical plan; group 2 consisted of lesions that might delay or alter the surgical procedure.

Results

We identified 268 patients (169 female), of mean age 39.1 ± 10.8 years, mean baseline body weight 108.7 ± 6.1 kg and mean body mass index (BMI) 40.3 ± 6.1 kg/m2 for analysis. Overall prevalence of abnormal OGD findings was 51.1 %, which included gastritis (32.5 %), hiatus hernia (17.9 %), duodenitis (8.6 %) and erosive oesophagitis (7.5 %); 27.2 % had group 2 lesions. Univariate analysis revealed older age (p = 0.016), use of NSAIDs (p = 0.004) and presence of reflux symptoms (p = 0.029) as significant risk factors of group 2 lesions. On multivariate analysis, use of NSAIDs (p = 0.015) and reflux symptoms (p = 0.039) remained significant predictive factors. In the low-risk subgroup (40 years and younger, without reflux symptoms or use of NSAIDs), the prevalence of group 2 abnormalities was 18.9 %.

Conclusions

Significant endoscopic abnormalities are common among obese Chinese patients which may delay or change the surgical plan. The negative predictive value in low-risk patients was not strong. We therefore recommend routine preoperative endoscopy for all patients.

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Authors and Affiliations

  1. Prince of Wales Hospital, Sha Tin, Hong Kong, China

    June Lee, Simon Kin-Hung Wong, Shirley Yuk-Wah Liu & Enders Kwok-Wai Ng

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  1. June Lee
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  2. Simon Kin-Hung Wong
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  3. Shirley Yuk-Wah Liu
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  4. Enders Kwok-Wai Ng
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Correspondence to June Lee.

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The authors declare that they have no conflict of interest.

Ethical Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Lee, J., Wong, S.KH., Liu, S.YW. et al. Is Preoperative Upper Gastrointestinal Endoscopy in Obese Patients Undergoing Bariatric Surgery Mandatory? An Asian Perspective. OBES SURG 27, 44–50 (2017). https://doi.org/10.1007/s11695-016-2243-8

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  • DOI: https://doi.org/10.1007/s11695-016-2243-8

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