Obesity Surgery

, Volume 18, Issue 9, pp 1067–1073 | Cite as

Preoperative Endoscopic Screening for Laparoscopic Roux-en-Y Gastric Bypass has a Low Yield for Anatomic Findings

  • Cindy Mong
  • Jacques Van Dam
  • John Morton
  • Lauren Gerson
  • Myriam Curet
  • Subhas Banerjee
Research Article

Abstract

Background

Patients undergoing laparoscopic Roux-en-Y bariatric surgery undergo screening esophagoduodenoscopy (EGD) during preoperative evaluation. The hypothesis is to examine the utility of this examination. The purpose of this study was to evaluate the prevalence of clinically significant upper gastrointestinal (UGI) tract findings at screening EGD in patients undergoing laparoscopic Roux-en-Y bariatric surgery. A secondary aim was to determine whether preprocedure symptoms could predict findings at EGD.

Methods

We evaluated records of patients undergoing EGD prior to bariatric surgery between 2000 and 2005 at the Stanford University Medical Center. Clinical, endoscopic, and pathological data were analyzed. The prevalence of endoscopic findings of clinical significance was determined.

Results

Two hundred seventy two complete patient records were identified and included in the study. Of these, 237 (87%) were female and 197 (72%) were Caucasian. The mean age was 43 ± 9.68 years and mean body mass index was 48 ± 7.95 kg/m2. Of the 272 patients, 33 (12%) had EGD findings of clinical significance including erosive esophagitis (3.7%), Barrett’s esophagus (3.7%), gastric ulcers (2.9%), erosive gastritis (1.8%), duodenal ulcers (0.7%), and gastric carcinoid (0.3%). No patients had malignancy. Of these 33 patients, 22 (67%) had UGI symptoms.

Conclusions

Significant findings at screening EGD were found in 12% of patients. While EGD may be low-yield, the findings could be useful in guiding clinical decision making.

Keywords

Morbid obesity Gastric bypass Upper endoscopy Roux-en-Y gastric bypass Bariatric surgery Laparoscopic adjustable gastric bypass Upper GI malignancy Gastroesophgeal reflux Screening endoscopy 

Notes

Acknowledgements

Cindy Mong was supported by the Stanford University Medical Scholars Program and the American Gastroenterological Association Student Research Fellowship and Travel Award. We thank Doris Wang for secretarial support. Portions of this work were presented at the Digestive Disease Week (Gastroenterology 2006).

References

  1. 1.
    Hedley AA, Ogden CL, Johnson CL, et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA. 2004;291:2847–50.PubMedCrossRefGoogle Scholar
  2. 2.
    Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.PubMedCrossRefGoogle Scholar
  3. 3.
    Encinosa WE, Bernard DM, Steiner CA, et al. Use and costs of bariatric surgery and prescription weight-loss medications. Health Aff (Millwood). 2005;24:1039–46.CrossRefGoogle Scholar
  4. 4.
    Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.PubMedCrossRefGoogle Scholar
  5. 5.
    Sauerland S, Angrisani L, Belachew M, et al. Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2005;19:200–21.PubMedCrossRefGoogle Scholar
  6. 6.
    Valencia-Flores M, Orea A, Castano VA, et al. Prevalence of sleep apnea and electrocardiographic disturbances in morbidly obese patients. Obes Res. 2000;8:262–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Dhariwal A, Plevris JN, Lo NT, et al. Age, anemia, and obesity-associated oxygen desaturation during upper gastrointestinal endoscopy. Gastrointest Endosc. 1992;38:684–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Madan AK TD, Isom J, Minard G, Bee TK. Monitored anesthesia care with propofol versus surgeon-monitored sedation with benzodiazepines and narcotics for preoperative endoscopy in the morbidly obese. Obes Surg. 2008;18:545–8.CrossRefPubMedGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    Schirmer B, Erenoglu C, Miller A. Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. Obes Surg. 2002;12:634–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Sharaf RN, Weinshel EH, Bini EJ, et al. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg. 2004;14:1367–72.PubMedCrossRefGoogle Scholar
  12. 12.
    Madan AK, Speck KE, Hiler ML. Routine preoperative upper endoscopy for laparoscopic gastric bypass: is it necessary? Am Surg. 2004;70:684–6.PubMedGoogle Scholar
  13. 13.
    Korenkov M, Sauerland S, Shah S, et al. Is routine preoperative upper endoscopy in gastric banding patients really necessary? Obes Surg. 2006;16:45–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Zeni TM, Frantzides CT, Mahr C, et al. Value of preoperative upper endoscopy in patients undergoing laparoscopic gastric bypass. Obes Surg. 2006;16:142–6.PubMedCrossRefGoogle Scholar
  15. 15.
    NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115:956–61.Google Scholar
  16. 16.
    Office of the Surgeon General. The Surgeon General’s call to action to prevent and decrease overweight and obesity. Public Health Service, Office of the Surgeon General 2001. Washington, DC: U.S. Department of Health and Human Services; 2001.Google Scholar
  17. 17.
    Klaus AGI, Wetscher G, Nehoda H, Aigner F, Peer R, Margreiter R, et al. Prevalent esophageal body motility disorders underlie aggravation of GERD symptoms in morbidly obese patients following adjustable gastric banding. Arch Surg. 2006;141:247–51.PubMedCrossRefGoogle Scholar
  18. 18.
    Merrouche MSJ, Jouet P, Harnois F, Scaringi S, Coffin B, Msika S. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17:894–900.PubMedCrossRefGoogle Scholar
  19. 19.
    Gutschow CACP, Prenzel K, Hölscher AH, Schneider PM. Long-term results and gastroesophageal reflux in a series of laparoscopic adjustable gastric banding. J Gastrointest Surg. 2005;9:941–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Milone L, Daud A, Durak E, Olivero-Rivera L, Schrope B, Inabnet WB, et al. Esophageal dilation after laparoscopic adjustable gastric banding. Surg Endosc. 2008;22:1482–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Alami RSSR, Friedland S, Curet MJ, Wren SM, Soetikno R, Morton JM, et al. Transnasal small-caliber esophagogastroduodenoscopy for preoperative evaluation of the high-risk morbidly obese patient. Surg Endosc. 2007;21:758–60.PubMedCrossRefGoogle Scholar
  22. 22.
    Rasmussen JJFW, Ali MR. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Surg Endosc. 2007;21:1090–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Delgado-Aros SLGr, Camilleri M, Talley NJ, Fett S, Zinsmeister AR, Melton LJ 3rd. Obesity is associated with increased risk of gastrointestinal symptoms: a population-based study. Am J Gastroenterol. 2004;99:1801–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Ries LAGHD, Krapcho M, Mariotto A, Miller BA, Feuer EJ, Clegg L, et al. (eds). SEER Cancer Statistics Review 1975–2003. National Cancer Institute, Bethesda MD. http://seer.cancer.gov/csr/1975-2003/ (2005).Google Scholar
  25. 25.
    Lagergren JYW, Bergström R, Nyrén O. Utility of endoscopic screening for upper gastrointestinal adenocarcinoma. JAMA. 2000;284:961–2.PubMedCrossRefGoogle Scholar
  26. 26.
    De Roover ADO, Desaive C, Maweja S, Coimbra C, Honoré P, Meurisse M. Risk of upper gastrointestinal cancer after bariatric operations. Obes Surg. 2006;16:1656–61.PubMedCrossRefGoogle Scholar
  27. 27.
    Harper JLBD, Tichansky DS, Madan AK. Cancer in the bypassed stomach presenting early after gastric bypass. Obes Surg. 2007;17:1268–71.PubMedCrossRefGoogle Scholar
  28. 28.
    Allori ACLI, Heitman E. Natural orifice transluminal endoscopic surgery: lessons learned from the laparoscopic revolution. Arch Surg. 2008;143:333–4.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Cindy Mong
    • 1
  • Jacques Van Dam
    • 1
  • John Morton
    • 2
  • Lauren Gerson
    • 1
  • Myriam Curet
    • 2
  • Subhas Banerjee
    • 1
    • 3
  1. 1.Department of Medicine, Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordUSA
  2. 2.Department of SurgeryStanford University School of MedicineStanfordUSA
  3. 3.Stanford University Medical CenterStanfordUSA

Personalised recommendations