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.
Similar content being viewed by others
References
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.
Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.
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.
Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.
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.
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.
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.
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.
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.
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.
Sharaf RN, Weinshel EH, Bini EJ, et al. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg. 2004;14:1367–72.
Madan AK, Speck KE, Hiler ML. Routine preoperative upper endoscopy for laparoscopic gastric bypass: is it necessary? Am Surg. 2004;70:684–6.
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.
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.
NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115:956–61.
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.
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.
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.
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.
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.
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.
Rasmussen JJFW, Ali MR. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Surg Endosc. 2007;21:1090–4.
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.
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).
Lagergren JYW, Bergström R, Nyrén O. Utility of endoscopic screening for upper gastrointestinal adenocarcinoma. JAMA. 2000;284:961–2.
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.
Harper JLBD, Tichansky DS, Madan AK. Cancer in the bypassed stomach presenting early after gastric bypass. Obes Surg. 2007;17:1268–71.
Allori ACLI, Heitman E. Natural orifice transluminal endoscopic surgery: lessons learned from the laparoscopic revolution. Arch Surg. 2008;143:333–4.
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).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mong, C., Van Dam, J., Morton, J. et al. Preoperative Endoscopic Screening for Laparoscopic Roux-en-Y Gastric Bypass has a Low Yield for Anatomic Findings. OBES SURG 18, 1067–1073 (2008). https://doi.org/10.1007/s11695-008-9600-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-008-9600-1