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Pre-screening for bariatric surgery patients: comparative effectiveness of transnasal endoscopy versus esophagogastroduodenoscopy

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Abstract

Background

Endoscopic evaluation is frequently performed before bariatric surgery to identify foregut pathology that may alter procedure selection. Transnasal endoscopy (TNE) is an alternative to esophagogastroduodenoscopy (EGD). The objective of this study was to compare TNE to EGD.

Methods

Patients who underwent TNE or EGD before bariatric surgery from January 2012 through April 2019 were reviewed. Statistical analyses included Chi-square, Wilcoxon two-sample, and Fisher’s exact tests. A p value < 0.05 was considered significant.

Results

Three hundred and forty-five patients underwent preoperative screening (63% EGD, 37% TNE) before bariatric surgery. Mean age and preoperative body mass index in the TNE and EGD groups were 46.2 ± 12.4 vs 45.5 ± 11.6 years (p = 0.58) and 46.5 ± 7.1 vs. 45.5 ± 6.1 kg/m2 (p = 0.25), respectively. Three TNEs were aborted, resulting in a success rate of 98%. Of patients who underwent EGD, 1 (0.5%) visited the emergency department (ED), and 7 (3%) called the nurse with post-procedure concerns. There were no ED visits or nurse calls from patients who underwent TNE. The median total time in the procedure room was 77 (57–97) min for EGD vs. 26 (8–33) min for TNE (p < 0.001). One patient who underwent TNE required subsequent EGD. Mean charge per patient for EGD and TNE was $5034.70 and $1464.00, respectively.

Conclusions

TNE was associated with less post-procedure care, shorter procedure time and fewer charges compared to EGD. TNE could be considered an initial screening tool for patients undergoing bariatric surgery, while EGD could be used selectively in patients with abnormal TNE findings.

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Authors and Affiliations

  1. Department of Medical Research, Gundersen Health System, La Crosse, WI, USA

    Austin M. DeBoer, Susan M. Frankki & Kara J. Kallies

  2. Department of Medical Education, Gundersen Health System, La Crosse, WI, USA

    Katelyn M. Mellion

  3. Department of General Surgery, Gundersen Health System, 1900 South Ave. C05-001, La Crosse, WI, 54601, USA

    Brandon T. Grover, Joshua D. Pfeiffer & Shanu N. Kothari

Authors
  1. Austin M. DeBoer
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  2. Katelyn M. Mellion
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  3. Susan M. Frankki
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  4. Kara J. Kallies
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  5. Brandon T. Grover
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  7. Shanu N. Kothari
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Corresponding author

Correspondence to Brandon T. Grover.

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Disclosures

Dr. Kothari is a proctor for Torax Medical, Inc. and speaker for GORE, both of these are outside the submitted work. Mr. DeBoer, Dr. Mellion, Ms. Frankki, Ms. Kallies, Dr. Grover, and Dr. Pfeiffer have no conflicts of interest or financial ties to disclose.

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DeBoer, A.M., Mellion, K.M., Frankki, S.M. et al. Pre-screening for bariatric surgery patients: comparative effectiveness of transnasal endoscopy versus esophagogastroduodenoscopy. Surg Endosc 35, 4153–4159 (2021). https://doi.org/10.1007/s00464-020-07892-y

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  • DOI: https://doi.org/10.1007/s00464-020-07892-y

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