Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 9/2018

01-09-2018 | Original Contributions

High-Percentage Pathological Findings in Obese Patients Suggest that Esophago-gastro-duodenoscopy Should Be Made Mandatory Prior to Bariatric Surgery

Authors: Mizelle D’Silva, Aparna Govil Bhasker, Nimisha S. Kantharia, Muffazal Lakdawala

Published in: Obesity Surgery | Issue 9/2018

Login to get access

Abstract

Obesity is a global epidemic and will soon become the number one priority in healthcare management. Bariatric surgery causes a significant improvement in obesity and its related complications. Pre-operative esophago-gastro-duodenoscopy (EGD) is done by several bariatric surgical teams across the world but is still not mandatory.

Aim

To study the percentage of symptomatic and asymptomatic pathological EGD findings in obese patients undergoing bariatric surgery and to analyze whether these findings influence the eventual choice of bariatric surgery.

Materials and Methods

All patients posted for bariatric surgery at our institute from January 2015 to March 2017 had a pre-operative EGD done by the same team of endoscopists.

Results

In this study, totally, 675 patients were assessed prior to routine bariatric surgery. 78.52% of all pre-operative patients had an abnormal EGD. The most common endoscopic abnormalities found were hiatus hernia (52.44%), gastritis (46.22%), presence of Helicobacter (H.) pylori (46.67%), reflux esophagitis (16.89%), Barrett’s esophagus (1.78%), gastric erosions (13.19%), and polyps (7.41%). Fifty patients had upper gastrointestinal polyps: 41 in the stomach, 3 in the esophagus, and 6 in the duodenum, mostly benign hyperplastic or inflammatory polyps. Two patients had gastrointestinal stromal tumor (GIST), 6 leiomyoma, and 6 neuroendocrine tumors (NET). Of those with endoscopic evidence of gastroesophageal reflux disease (GERD), 70 (60.03%) of patients were asymptomatic. The pre-operative EGD findings resulted in a change of the planned surgical procedure in 67 (9.93%) patients.

Conclusion

Our study suggests that a large percentage of patients undergoing bariatric surgery have pathologically significant endoscopic findings of which a significant number are asymptomatic; this can lead to a change in the planned bariatric procedure in a section of patients; hence, we believe that EGD should be made mandatory as a pre-operative investigation in all bariatric surgery patients.
Literature
1.
Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and over-weight: a systematic review and meta-analysis. BMC Public Health. 2009;25:88.CrossRef
2.
Muñoz R, Ibáñez L, Salinas J, et al. Importance of routine pre-operative upper GI endoscopy: why all patients should be evaluated? Obes Surg. 2009;19:427–31.CrossRef
3.
Wadden TA, Frey DL. A multicenter evaluation of a proprietary weight loss program for the treatment of marked obesity: a five-year follow-up. International Journal of Eating Disorders. 22(2):203–12.
4.
Rosenthal RJ. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obesity Rel Dis. 2012;8:8–19.CrossRef
5.
Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles Classification. Gut. 1999;45:172–80.CrossRef
6.
Hill AD, Kozarek RA, Kraemer SJM, et al. The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc. 1996;44:541–7.CrossRef
7.
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.CrossRef
8.
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.CrossRef
9.
Anderson MA, Gan SI, Fanelli RD, et al. ASGE guideline: role of endoscopy in the bariatric surgery patient. Gastrointest Endosc. 2008;68:1–10.CrossRef
10.
Sharaf RN, Weinshel EH, Bini EJ, et al. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg. 2004; Nov-Dec;14(10):1367–72.CrossRef
11.
Kakar K, Singhal V, Khaitan L. Preoperative upper endoscopy should be standard of care for patients undergoing bariatric surgery. SAGES 2014
12.
Victoria Gomez MD, Rajat Bhalla MD, et al. Routine screening endoscopy before bariatric surgery: is it necessary? Bariatric Surgery Practice Patient Care. 2014;9(4):143–9.CrossRef
13.
Rodriguez Diez, Maria D. et al. Upper endoscopy findings in obese morbid patients candidates for bariatric surgery. Gastroenterol Hepatol 2015; 38(7): 426–430.
14.
Bennett S et al. The role of routine preoperative upper endoscopy in bariatric sx: a systematic review and meta analysis. Surg Obes Relat Dis. 2016;12(5):1116–23.CrossRef
15.
Di Francesco V, Baggio E, Mastromauro M, et al. Obesity and gastro- esophageal acid reflux: physiopathological mechanisms and role of gastric bariatric surgery. Obes Surg. 2004;14:1095–102.CrossRef
16.
Bhumika V, Arvind B, Pragati M, et al. Gastroesophageal Reflux disease and its association with BMI: Clinical and Endoscopic Study. J Clin Diagn Res. 2017;11(4):OC01–4.
17.
El-Serag H. The association between obesity and GERD : a review of the epidemiological evidence. Dig Dis Sci. 2008 Sep;53(9):2307–12.CrossRef
18.
Bennett S, Gostimir M, Shorr R, et al. The role of routine preoperative upper endoscopy in bariatric surgery : a systematic review and meta-analysis. Surg Obes Relat Dis. 2016;12(5):1116–25.CrossRef
19.
20.
Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis. 2017;13:568–74.CrossRef
21.
Cobey F, Oelschlager B. Complete regression of Barrett’s esophagus after Roux-en-Y gastric bypass. Obes Surg. 2005;15(5):710–2.CrossRef
22.
Rasmussen JJ, Fuller W, Ali MR. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Surg Endosc. 2007;21(7):1090–4.CrossRef
23.
Loewen M, Giovanni J, Barba C. Screening endoscopy before bariatric surgery: a series of 448 patients. Surg Obes Relat Dis. 2008;4:709–12.CrossRef
24.
Foster A, Richards WO, McDowell J, et al. Gastrointestinal symptoms are more intense in morbidly obese patients. Surg Endosc. 2003;17:1766–8.CrossRef
25.
Howard DD, Caban AM, Cendan JC, et al. Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Surg Obes Relat Dis. 2011;7:709–13.CrossRef
26.
DuPree CE, Blair K, et al. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease, a national analysis. JAMA Surgery. 2014;149(4):328–34.CrossRef
27.
Adlekha C et al. Prevalence of H. Pylori infection among patients undergoing upper gastrointestinal endoscopy in a Medical College Hospital in Kerela, India. Ann Med Health Sci Res. 2013;3(4):559–63.CrossRef
28.
Hooi KY, Wong WS, Kaplan GG, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017;153(2):420–9.CrossRef
29.
Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus. Gut. 2012;61:646–64.CrossRef
30.
Papasavas PK, Gagne DJ, Donnelly PE, et al. Prevalence of Helicobacter pylori infection and value of preoperative testing and treatment in patients undergoing laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4(3):383–8.CrossRef
31.
Erim T, Cruz-Correa MR, Szomstein S, et al. Prevalence of Helicobacter pylori seropositivity among patients undergoing bariatric surgery: a preliminary study. World J Surg. 2008;32:2021–5.CrossRef
32.
Verma S, Sharma D, Kanwar P, et al. Prevalence of helicobacter pylori infection in bariatric patients: a histologic assessment. Surg Obes Relat Dis. 2013;9:679–85.CrossRef
33.
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.CrossRef
34.
Sharaf RN, Weinshel EH, Bini EJ, et al. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg. 2004;14:1367–72.CrossRef
35.
Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient – 2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic and Bariatric Surgery. Obesity. 2013;21:S1–S27.CrossRef
36.
ASGE Standards of Practice Committee. The role of endoscopy in the bariatric surgery patient. Surg Endosc. 2015 May;29(5):1007–17.CrossRef
37.
Sauerland S, Angrisani L, Belachew M, et al. Obesity surgery. Evidence-based guidelines of the European Association for Endoscopic Surgery (E.A.E.S.). Surg Endosc. 2005;19:200–21.CrossRef
Metadata
Title
High-Percentage Pathological Findings in Obese Patients Suggest that Esophago-gastro-duodenoscopy Should Be Made Mandatory Prior to Bariatric Surgery
Authors
Mizelle D’Silva
Aparna Govil Bhasker
Nimisha S. Kantharia
Muffazal Lakdawala
Publication date
01-09-2018
Publisher
Springer US
Published in
Obesity Surgery / Issue 9/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-018-3230-z

Other articles of this Issue 9/2018

Obesity Surgery 9/2018 Go to the issue

Original Contributions

Sleeve Gastrectomy in Morbidly Obese HIV Patients: Focus on Anti-retroviral Treatment Absorption After Surgery

Original Contributions

Factors Influence the Acceptance of Surgical Treatment in Chinese Bariatric Surgery Candidates

Original Contributions

Long-Term Relationship Between Tobacco Use and Weight Loss after Sleeve Gastrectomy

Original Contributions

Performance on the Montreal Cognitive Assessment (MoCA) in Older Adults Presenting for Bariatric Surgery

Original Contributions

Role of Routine Abdominal Ultrasound Before Bariatric Surgery: Review of 937 Patients

Original Contributions

Increased Bile Acids and FGF19 After Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Correlate with Improvement in Type 2 Diabetes in a Randomized Trial