Technique, risks, and true impact of routine preoperative endoscopic evaluation of morbidly obese patients undergoing bariatric surgery

Excerpt

In their report on upper digestive endoscopy prior to bariatric surgery, Küper et al. [1] state that “endoscopy can be performed safely, but anesthesiological support is strongly recommended in patients with critical condition.” The authors did not define critical conditions, but one of these is likely sleep apnea syndrome because the incidence of hypoxemia requiring emergency bronchoscopy was significantly higher in patients affected with this syndrome compared to those who were not [2/14 (14%) vs. 0/51, respectively; p < 0.05 (two-tailed Fisher exact test)]. Also, I think that a procedure that resulted in extremely severe hypoxemia (SaO₂ < 60%) and required emergency bronchoscopy for intratracheal O₂ insufflation in 3% of patients can hardly be regarded as safe. According to a recent survey [2], approximately 350,000 bariatric surgery procedures were performed in 2008 in 36 nations; systematic preoperative endoscopy in these patients (as recommended by the authors) in the conditions described by Küper et al. would have put 10,000 persons at risk of iatrogenic complications. …