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Importance of Routine Preoperative Upper GI Endoscopy: Why All Patients Should Be Evaluated?

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Abstract

Background

Morbid obesity is associated with different gastrointestinal alterations and diseases. Surgically induced weight loss has become the best treatment for morbidly obese patients. Roux-en-Y gastric bypass is the most common procedure performed worldwide. Concerns regarding difficulties in further evaluation of stomach remnant for early detection of gastric cancer, however, have emphasized the routine use of preoperative upper endoscopy, even in asymptomatic patients, to detect upper gastrointestinal abnormalities. The main outcome of this study was to identify the most common preoperative endoscopic findings.

Methods

Data was collected from a prospective database and medical records of patients with available endoscopic reports, who underwent Roux-en-Y gastric bypass from February 1999 to June 2006. Logistic regression analysis was performed to detect preoperative clinical variables that might be associated with abnormal endoscopy.

Results

Six hundred twenty-six patients were identified. Four hundred fifty-two (72%) were female; age and body mass index were 38.5 ± 11.3 years and 42 ± 6.5 kg/m2, respectively. Abnormalities were found in 288 (46%) patients. The age of patients with abnormal and normal endoscopy was 40 ± 11 and 36.8 ± 11 years, respectively (p < 0.001). The most common findings were gastritis 21% (n = 132), esophagitis 16% (n = 100), and hiatal hernia 10.7% (n = 67). Duodenitis has a frequency of 7.8% (n = 49), gastric ulcers of 2.7%(n = 17), duodenal ulcers of 2.6% (n = 16), gastric polyps of 1.3% (n = 8), Barrett’s esophagus of 0.16% (n = 1), and gastric cancer of 0.16% (n = 1). Age was the only clinical variable associated to abnormal endoscopy (odds ratio = 1.03; 95% confidence interval, 1.02–1.05).

Conclusions

Routine preoperative endoscopy detects different abnormalities which need specific approach prior to surgery. Preoperative endoscopy should be performed to all patients prior to surgery.

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Acknowledgements

Dr. Muñoz scholarship is funded by MECESUP and Faculty of Medicine, Pontificia Universidad Católica de Chile. Authors want to thanks Dr. Osvaldo Llanos for its comments and revision of the manuscript.

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Authors and Affiliations

  1. Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta #350, Santiago, Chile

    Rodrigo Muñoz, Luis Ibáñez, José Salinas, Alex Escalona, Gustavo Pérez, Fernando Pimentel, Sergio Guzmán & Camilo Boza

  2. Medical Sciences PhD Program, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

    Rodrigo Muñoz

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  1. Rodrigo Muñoz
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  2. Luis Ibáñez
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  3. José Salinas
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  4. Alex Escalona
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  5. Gustavo Pérez
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  6. Fernando Pimentel
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  7. Sergio Guzmán
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  8. Camilo Boza
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Correspondence to Camilo Boza.

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Muñoz, R., Ibáñez, L., Salinas, J. et al. Importance of Routine Preoperative Upper GI Endoscopy: Why All Patients Should Be Evaluated?. OBES SURG 19, 427–431 (2009). https://doi.org/10.1007/s11695-008-9673-x

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  • DOI: https://doi.org/10.1007/s11695-008-9673-x

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