Preoperative Upper-GI Endoscopy Prior to Bariatric Surgery: Essential or Optional?
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ORIGINAL CONTRIBUTIONS
Preoperative Upper-GI Endoscopy Prior to Bariatric Surgery: Essential or Optional? Yusef Moulla 1,2 & Orestis Lyros 1 & Matthias Mehdorn 1 & Undine Lange 1,2 & Haitham Hamade 1 & Rene Thieme 1 & Albrecht Hoffmeister 3 & Jürgen Feisthammel 3 & Matthias Blueher 2 & Boris Jansen-Winkeln 1 & Ines Gockel 1 & Arne Dietrich 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction The role of preoperative upper-gastrointestinal (GI) gastroscopy has been discussed with controversy in bariatric surgery. The aim of this study was to evaluate the incidence of upper-GI pathologies detected via endoscopy prior to bariatric surgery along with their clinical significance for patients’ management. Material and Methods In our single center prospectively established database of obese patients, who underwent bariatric surgery from January 2011 to December 2017, we retrospectively analyzed the perioperative endoscopic findings along with their influence on patients’ management. Results In total, 636 obese patients with median BMI (body mass index) of 49 kg/m2 [range 31–92] received an upper-GI endoscopy prior to bariatric surgery. Among the surgical procedures, laparoscopic Roux-Y-gastric bypass (72.6%; n = 462) was the most frequent operation. Endoscopically detected pathological conditions were peptic ulcer 3.5% (22/636), Helicobacter pylori (Hp) gastritis 22.4% (143/636), and gastric or duodenal polyps 6.8% (43/636). Reflux esophagitis could be detected in 139/636 patients (21.9%). Barrett’s esophagus (BE) was histologically diagnosed in 95 cases (15.0%), whereas BE was suspected endoscopically in 75 cases (11.3%) only. Esophageal adenocarcinomas were detected in 3 cases (0.5%). Change of the operative strategy due to endoscopically or histologically detected pathologic findings had to be performed in 10 cases (1.6%). Conclusion Preoperative upper-GI endoscopy identifies a wide range of abnormal endoscopic findings in obese patients, which may have a significant impact on decision-making, particularly regarding the most suitable bariatric procedure and the appropriate follow-up. Therefore, preoperative upper-GI endoscopy should be considered in all obese patients prior to bariatric procedure. Keywords Preoperative endoscopy . Perioperative management . GERD . Barrett’s esophagus . Bariatric surgery
Introduction The incidence of morbid obesity has rapidly been increasing in the last decades along with the number of bariatric * Yusef Moulla [email protected] 1
Department of Abdominal, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstrasse 20, D-04103 Leipzig, Germany
2
Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig, Germany
3
Clinic for Gastroenterology, Department of Internal Medicine, University Hospital of Leipzig, Liebigstrasse 20, D-04103 Leipzig, Germany
procedures worldwide simultaneously. Currently, bariatric surgery is considered the most effective therapy for morbid obesity wh
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