Is Routine Preoperative Esophagogastroduodenoscopy Prior to Bariatric Surgery Mandatory? Systematic Review and Meta-anal
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ORIGINAL CONTRIBUTIONS
Is Routine Preoperative Esophagogastroduodenoscopy Prior to Bariatric Surgery Mandatory? Systematic Review and Meta-analysis of 10,685 Patients Walid El Ansari 1,2,3 Abdulla Al-Ansari 1
&
Ayman El-Menyar 4,5 & Brijesh Sathian 4 & Hassan Al-Thani 6 & Mohammed Al-Kuwari 7 &
# The Author(s) 2020
Abstract Background This systematic review and meta-analysis searched, retrieved and synthesized the evidence as to whether preoperative esophagogastroduodenoscopy (p-EGD) should be routine before bariatric surgery (BS). Methods Databases searched for retrospective, prospective, and randomized (RCT) or quasi-RCT studies (01 January 2000–30 April 2019) of outcomes of routine p-EGD before BS. STROBE checklist assessed the quality of the studies. P-EGD findings were categorized: Group 0 (no abnormal findings); Group 1 (abnormal findings that do not necessitate changing the surgical approach or postponing surgery); Group 2 (abnormal findings that change the surgical approach or postpone surgery); and Group 3 (findings that signify absolute contraindications to surgery). We assessed data heterogeneity and publication bias. Random effect model was used. Results Twenty-five eligible studies were included (10,685 patients). Studies were heterogeneous, and there was publication bias. Group 0 comprised 5424 patients (56%, 95% CI: 45–67%); Group 1, 2064 patients (26%, 95% CI: 23–50%); Group 2, 1351 patients (16%, 95% CI: 11–21%); and Group 3 included 31 patients (0.4%, 95% CI: 0–1%). Conclusion For 82% of patients, routine p-EGD did not change surgical plan/ postpone surgery. For 16% of patients, p-EGD findings necessitated changing the surgical approach/ postponing surgery, but the proportion of postponements due to medical treatment of H Pylori as opposed to “necessary” substantial change in surgical approach is unclear. For 0.4% patients, p-EGD findings signified absolute contraindication to surgery. These findings invite a revisit to whether p-EGD should be routine before BS, and whether it is judicious to expose many obese patients to an invasive procedure that has potential risk and insufficient evidence of effectiveness. Further justification is required. Keywords Preoperative . Esophagogastroduodenoscopy . Laparoscopic sleeve gastrectomy . Bariatric surgery
* Walid El Ansari [email protected] Ayman El-Menyar [email protected] Brijesh Sathian [email protected] Hassan Al-Thani [email protected] Mohammed Al-Kuwari [email protected] Abdulla Al-Ansari [email protected]
1
Department of Surgery, Hamad Medical Corporation, Doha, Qatar
2
College of Medicine, Qatar University, Doha, Qatar
3
Schools of Health and Education, University of Skovde, Skövde, Sweden
4
Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
5
Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
6
Department of Surgery, Trauma and Vascular Surgery Section, Hamad Medical Corporation, Doha, Qatar
7
Department of Bariatric Surgery, Hamad Medical Corporatio
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