Role of routine upper endoscopy before bariatric surgery in the Middle East population: a review of 1278 patients

Abstract

Introduction The routine use of preoperative endoscopy for patients undergoing bariatric surgery is controversial. Although many surgeons find it unnecessary, others still consider it a mandatory tool in preoperative assessment.

Patients and methods We reviewed the medical records of all patients who had undergone preoperative endoscopy before bariatric surgery in Rashid Hospital between January 2013 and June 2016. The patients were divided into three groups: Group 0 included patients with normal endoscopy; Group 1 included patients with abnormalities that did not affect the timing or type of procedure; Group 2 included patients with abnormalities that had a direct impact on the procedure.

Results The files of 1473 patients were reviewed. Endoscopy results were not present in 195 files, so those patients were excluded, and the remaining 1278 files were included. The mean age of patients was 41.3 ± 12.7 years, 61 % were female and 39 % were male. The mean body mass index (BMI) was 43.7 ± 8 kg/m². Endoscopy was normal in 10.6 % of patients and abnormal in 89.4 %. The most common abnormalities were gastritis, positive Campylobacter-like organism test (CLO test), gastroesophageal reflux disease (GERD) with esophagitis and hiatal hernia. Group 0 included 10.6 % of patients (n = 135), Group 1 included 25.6 % of patients (n = 327), while Group 2 included 63.8 % of patients (n = 816).

Conclusion Routine endoscopy seems to play an important part in the preoperative preparation of patients planned for bariatric surgery in the Middle East population. Further studies or meta-analysis could help in building up clear solid evidence and guidelines that could be approved by international bariatric associations with regard to indications for preoperative upper endoscopy in bariatric patients.

• References

• 1 Lee J, Wong SKH, Liu SYW. et al. Is preoperative upper gastrointestinal endoscopy in obese patients undergoing bariatric surgery mandatory? An Asian perspective. Obes Surg 2017; 27: 44-50
• 2 Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults – The Evidence Report. National Institutes of Health. Obes Res 1998; 6 (Suppl. 02) 51S-209S
• 3 Abd Ellatif ME, Alfalah H, Asker WA. et al. Place of upper endoscopy before and after bariatric surgery: A multicenter experience with 3219 patients. World J Gastrointest Endosc 2016; 8: 409-417
• 4 Almazeedi S, Al-Sabah S, Alshammari D. et al. The impact of Helicobacter pylori on the complications of laparoscopic sleeve gastrectomy. Obes Surg 2014; 24: 412-415
• 5 Carabotti M, D’Ercole C, Iossa A. et al. Helicobacter pylori infection in obesity and its clinical outcome after bariatric surgery. World J Gastroenterol 2014; 20: 647-653
• 6 Merrouche M, Sabaté JM, Jouet P. et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg 2007; 17: 894-900
• 7 Greenstein RJ, Nissan A, Jaffin B. Esophageal anatomy and function in laparoscopic gastric restrictive bariatric surgery: implications for patient selection. Obes Surg 1998; 8: 199-206
• 8 Bernante P, Breda C, Zangrandi F. et al. Emergency sleeve gastrectomy as rescue treatment for acute gastric necrosis due to type II paraesophageal hernia in an obese woman with gastric banding. Obes Surg 2008; 18: 737-741
• 9 Loewen M, Giovanni J, Barba C. Screening endoscopy before bariatric surgery: a series of 448 patients. Surg Obes Relat Dis 2008; 4: 709-712
• 10 Peromaa-Haavisto P, Victorzon M. Is routine preoperative upper GI endoscopy needed prior to gastric bypass?. Obes Surg 2013; 23: 736-739
• 11 ASGE Standards of Practice Committee. The role of endoscopy in the bariatric surgery patient. Gastrointest Endosc 2015; 81: 1063-1072
• 12 Sauerland S, Angrisani L, Belachew M. et al. Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 2005; 19: 200-221
• 13 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 & Bariatric Surgery. Surg Obes Relat Dis 2013; 9: 159-191
• 14 Frigg A, Peterli R, Zynamon A. et al. Radiologic and endoscopic evaluation for laparoscopic adjustable gastric banding: preoperative and follow-up. Obes Surg 2001; 11: 594-599
• 15 Sharaf RN, Weinshel EH, Bini EJ. et al. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg 2004; 14: 1367-1372
• 16 Muñoz R, Ibáñez L, Salinas J. et al. Importance of routine preoperative upper GI endoscopy: why all patients should be evaluated?. Obes Surg 2009; 19: 427-431
• 17 Schigt A, Coblijn U, Lagarde S. et al. Is esophagogastroduodenoscopy before Roux-en-Y gastric bypass or sleeve gastrectomy mandatory?. Surg Obes Relat Dis 2014; 10: 411-417 ; quiz 565–566
• 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: 1116-1125
• 19 Korenkov M, Köhler L, Yücel N. et al. Esophageal motility and reflux symptoms before and after bariatric surgery. Obes Surg 2002; 12: 72-76
• 20 Miller K, Hell E. Laparoscopic surgical concepts of morbid obesity. Langenbecks Arch Surg 2003; 388: 375-384
• 21 Ng JY, Cheng AKS, Kim G. et al. Is elective gastroscopy prior to bariatric surgery in an Asian cohort worthwhile?. Obes Surg 2016; 26: 2156-2160
• 22 Zeni TM, Frantzides CT, Mahr C. et al. Value of preoperative upper endoscopy in patients undergoing laparoscopic gastric bypass. Obes Surg 2006; 16: 142-146