High-Percentage Pathological Findings in Obese Patients Suggest that Esophago-gastro-duodenoscopy Should Be Made Mandatory Prior to Bariatric Surgery
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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.
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.
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.
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.
KeywordsPre-operative esophago-gastro-duodenoscopy Bariatric surgery GERD Hiatus hernia Polyps Reflux esophagitis Barrett’s esophagus Neuroendocrine tumors Gastrointestinal stromal tumors Leiomyoma BMI
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.
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