Advertisement

Obesity Surgery

, Volume 28, Issue 9, pp 2753–2759 | Cite as

High-Percentage Pathological Findings in Obese Patients Suggest that Esophago-gastro-duodenoscopy Should Be Made Mandatory Prior to Bariatric Surgery

  • Mizelle D’SilvaEmail author
  • Aparna Govil Bhasker
  • Nimisha S. Kantharia
  • Muffazal Lakdawala
Original Contributions
  • 194 Downloads

Abstract

Obesity is a global epidemic and will soon become the number one priority in healthcare management. Bariatric surgery causes a significant improvement in obesity and its related complications. Pre-operative esophago-gastro-duodenoscopy (EGD) is done by several bariatric surgical teams across the world but is still not mandatory.

Aim

To study the percentage of symptomatic and asymptomatic pathological EGD findings in obese patients undergoing bariatric surgery and to analyze whether these findings influence the eventual choice of bariatric surgery.

Materials and Methods

All patients posted for bariatric surgery at our institute from January 2015 to March 2017 had a pre-operative EGD done by the same team of endoscopists.

Results

In this study, totally, 675 patients were assessed prior to routine bariatric surgery. 78.52% of all pre-operative patients had an abnormal EGD. The most common endoscopic abnormalities found were hiatus hernia (52.44%), gastritis (46.22%), presence of Helicobacter (H.) pylori (46.67%), reflux esophagitis (16.89%), Barrett’s esophagus (1.78%), gastric erosions (13.19%), and polyps (7.41%). Fifty patients had upper gastrointestinal polyps: 41 in the stomach, 3 in the esophagus, and 6 in the duodenum, mostly benign hyperplastic or inflammatory polyps. Two patients had gastrointestinal stromal tumor (GIST), 6 leiomyoma, and 6 neuroendocrine tumors (NET). Of those with endoscopic evidence of gastroesophageal reflux disease (GERD), 70 (60.03%) of patients were asymptomatic. The pre-operative EGD findings resulted in a change of the planned surgical procedure in 67 (9.93%) patients.

Conclusion

Our study suggests that a large percentage of patients undergoing bariatric surgery have pathologically significant endoscopic findings of which a significant number are asymptomatic; this can lead to a change in the planned bariatric procedure in a section of patients; hence, we believe that EGD should be made mandatory as a pre-operative investigation in all bariatric surgery patients.

Keywords

Pre-operative esophago-gastro-duodenoscopy Bariatric surgery GERD Hiatus hernia Polyps Reflux esophagitis Barrett’s esophagus Neuroendocrine tumors Gastrointestinal stromal tumors Leiomyoma BMI 

Notes

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Informed Consent

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

Statement of Human and Animal Rights

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

This article does not contain any studies with animals performed by any of the authors.

References

  1. 1.
    Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and over-weight: a systematic review and meta-analysis. BMC Public Health. 2009;25:88.CrossRefGoogle Scholar
  2. 2.
    Muñoz R, Ibáñez L, Salinas J, et al. Importance of routine pre-operative upper GI endoscopy: why all patients should be evaluated? Obes Surg. 2009;19:427–31.CrossRefGoogle Scholar
  3. 3.
    Wadden TA, Frey DL. A multicenter evaluation of a proprietary weight loss program for the treatment of marked obesity: a five-year follow-up. International Journal of Eating Disorders. 22(2):203–12.Google Scholar
  4. 4.
    Rosenthal RJ. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obesity Rel Dis. 2012;8:8–19.CrossRefGoogle Scholar
  5. 5.
    Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles Classification. Gut. 1999;45:172–80.CrossRefGoogle Scholar
  6. 6.
    Hill AD, Kozarek RA, Kraemer SJM, et al. The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc. 1996;44:541–7.CrossRefGoogle Scholar
  7. 7.
    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.CrossRefGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    Anderson MA, Gan SI, Fanelli RD, et al. ASGE guideline: role of endoscopy in the bariatric surgery patient. Gastrointest Endosc. 2008;68:1–10.CrossRefGoogle Scholar
  10. 10.
    Sharaf RN, Weinshel EH, Bini EJ, et al. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg. 2004; Nov-Dec;14(10):1367–72.CrossRefGoogle Scholar
  11. 11.
    Kakar K, Singhal V, Khaitan L. Preoperative upper endoscopy should be standard of care for patients undergoing bariatric surgery. SAGES 2014Google Scholar
  12. 12.
    Victoria Gomez MD, Rajat Bhalla MD, et al. Routine screening endoscopy before bariatric surgery: is it necessary? Bariatric Surgery Practice Patient Care. 2014;9(4):143–9.CrossRefGoogle Scholar
  13. 13.
    Rodriguez Diez, Maria D. et al. Upper endoscopy findings in obese morbid patients candidates for bariatric surgery. Gastroenterol Hepatol 2015; 38(7): 426–430.Google Scholar
  14. 14.
    Bennett S et al. The role of routine preoperative upper endoscopy in bariatric sx: a systematic review and meta analysis. Surg Obes Relat Dis. 2016;12(5):1116–23.CrossRefGoogle Scholar
  15. 15.
    Di Francesco V, Baggio E, Mastromauro M, et al. Obesity and gastro- esophageal acid reflux: physiopathological mechanisms and role of gastric bariatric surgery. Obes Surg. 2004;14:1095–102.CrossRefGoogle Scholar
  16. 16.
    Bhumika V, Arvind B, Pragati M, et al. Gastroesophageal Reflux disease and its association with BMI: Clinical and Endoscopic Study. J Clin Diagn Res. 2017;11(4):OC01–4.Google Scholar
  17. 17.
    El-Serag H. The association between obesity and GERD : a review of the epidemiological evidence. Dig Dis Sci. 2008 Sep;53(9):2307–12.CrossRefGoogle Scholar
  18. 18.
    Bennett S, Gostimir M, Shorr R, et al. The role of routine preoperative upper endoscopy in bariatric surgery : a systematic review and meta-analysis. Surg Obes Relat Dis. 2016;12(5):1116–25.CrossRefGoogle Scholar
  19. 19.
    Felsenreich D, Kefurt R, Schermann M, et al. Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg. 2017;  https://doi.org/10.1007/s11695-017-2748-9.
  20. 20.
    Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis. 2017;13:568–74.CrossRefGoogle Scholar
  21. 21.
    Cobey F, Oelschlager B. Complete regression of Barrett’s esophagus after Roux-en-Y gastric bypass. Obes Surg. 2005;15(5):710–2.CrossRefGoogle Scholar
  22. 22.
    Rasmussen JJ, Fuller W, Ali MR. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Surg Endosc. 2007;21(7):1090–4.CrossRefGoogle Scholar
  23. 23.
    Loewen M, Giovanni J, Barba C. Screening endoscopy before bariatric surgery: a series of 448 patients. Surg Obes Relat Dis. 2008;4:709–12.CrossRefGoogle Scholar
  24. 24.
    Foster A, Richards WO, McDowell J, et al. Gastrointestinal symptoms are more intense in morbidly obese patients. Surg Endosc. 2003;17:1766–8.CrossRefGoogle Scholar
  25. 25.
    Howard DD, Caban AM, Cendan JC, et al. Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Surg Obes Relat Dis. 2011;7:709–13.CrossRefGoogle Scholar
  26. 26.
    DuPree CE, Blair K, et al. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease, a national analysis. JAMA Surgery. 2014;149(4):328–34.CrossRefGoogle Scholar
  27. 27.
    Adlekha C et al. Prevalence of H. Pylori infection among patients undergoing upper gastrointestinal endoscopy in a Medical College Hospital in Kerela, India. Ann Med Health Sci Res. 2013;3(4):559–63.CrossRefGoogle Scholar
  28. 28.
    Hooi KY, Wong WS, Kaplan GG, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017;153(2):420–9.CrossRefGoogle Scholar
  29. 29.
    Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus. Gut. 2012;61:646–64.CrossRefGoogle Scholar
  30. 30.
    Papasavas PK, Gagne DJ, Donnelly PE, et al. Prevalence of Helicobacter pylori infection and value of preoperative testing and treatment in patients undergoing laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4(3):383–8.CrossRefGoogle Scholar
  31. 31.
    Erim T, Cruz-Correa MR, Szomstein S, et al. Prevalence of Helicobacter pylori seropositivity among patients undergoing bariatric surgery: a preliminary study. World J Surg. 2008;32:2021–5.CrossRefGoogle Scholar
  32. 32.
    Verma S, Sharma D, Kanwar P, et al. Prevalence of helicobacter pylori infection in bariatric patients: a histologic assessment. Surg Obes Relat Dis. 2013;9:679–85.CrossRefGoogle Scholar
  33. 33.
    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.CrossRefGoogle Scholar
  34. 34.
    Sharaf RN, Weinshel EH, Bini EJ, et al. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg. 2004;14:1367–72.CrossRefGoogle Scholar
  35. 35.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient – 2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic and Bariatric Surgery. Obesity. 2013;21:S1–S27.CrossRefGoogle Scholar
  36. 36.
    ASGE Standards of Practice Committee. The role of endoscopy in the bariatric surgery patient. Surg Endosc. 2015 May;29(5):1007–17.CrossRefGoogle Scholar
  37. 37.
    Sauerland S, Angrisani L, Belachew M, et al. Obesity surgery. Evidence-based guidelines of the European Association for Endoscopic Surgery (E.A.E.S.). Surg Endosc. 2005;19:200–21.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.General SurgerySaifee HospitalMumbaiIndia

Personalised recommendations