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Assakran BS, Al-Lihimy AS, Alkuraydis SA, Alsamaani AM, Alabdulaaly GS, Alshaya DK, Alkhoshiban OE. Histopathological Analysis Post Sleeve Gastrectomy: Value and Correlation With Preoperative Endoscopic Findings. Cureus 2025; 17:e78853. [PMID: 40084329 PMCID: PMC11905870 DOI: 10.7759/cureus.78853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2025] [Indexed: 03/16/2025] Open
Abstract
Background Laparoscopic sleeve gastrectomy (LSG) is one of the most common bariatric surgical procedures performed today. Before LSG, patients undergo an endoscopic examination to assess for any significant pathology that could affect the surgical outcome. Following LSG, the resected stomach tissue is routinely submitted for histopathological analysis, though the practice's efficacy remains debated. Furthermore, formal guidelines and recommendations for this practice are lacking. Methodology This retrospective single-center analysis was conducted at King Fahad Specialist Hospital (KFSH) in Buraydah, Al-Qassim. Following ethical approval, all patients with obesity who underwent LSG at our institution between 2017 and 2024 and whose medical records contained complete data were included in this study. Patient data meeting the inclusion criteria were then collected through a review of medical records. Data were collected using a standardized collection sheet. Results This study included 908 patients with obesity. Of the 908 patients, 547 (60.2%) were female and 361 (39.8%) were male. The vast majority, 893 (98.3%), were Saudi nationals. Participants had a mean age of 35.16 ± 13.049 years and a mean BMI of 44.08 ± 7.095 kg/m2. Preoperative gastroscopy revealed no mucosal abnormalities, ulcers, polyps, or vascular lesions in 421 patients (99.3%). Histopathological examination (HPE) of the resected tissue identified premalignant lesions in three patients (0.7%), with no malignancies detected. Conclusions This study highlights the value of HPE and its correlation with preoperative endoscopic findings in patients undergoing LSG. Given the low prevalence of malignancy, routine HPE may not be warranted. Therefore, HPE should be considered selectively to reduce costs and effort.
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Affiliation(s)
| | | | | | | | | | | | - Ola E Alkhoshiban
- Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
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Yadlapati S, Sánchez-Luna SA, Gromski MA, Mulki R. Managing the Bariatric Surgery Patient: Presurgery and Postsurgery Considerations. Gastrointest Endosc Clin N Am 2024; 34:627-638. [PMID: 39277295 DOI: 10.1016/j.giec.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Obesity has extensive health repercussions, and bariatric surgery remains a viable solution to address this issue. This article focuses on the preoperative and postoperative management strategies required to achieve successful and durable outcomes in bariatric surgery patients. Preoperative assessment includes appropriate patient selection, psychosocial evaluation, nutritional analysis, and behavioral/medical counseling. Postoperative assessment includes immediate perioperative care, diet transition, nutritional needs management, and handling of complications associated with bariatric surgery.
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Affiliation(s)
- Sujani Yadlapati
- Department of Gastroenterology and Hepatology, Indiana University Health, Indiana University School of Medicine, 550 University Boulevard, Indianapolis, IN 46202, USA
| | - Sergio A Sánchez-Luna
- Department of Gastroenterology and Hepatology, University of Alabama, Heersink School of Medicine, 1720 university Boulevard, Birmingham, AL 35294, USA
| | - Mark A Gromski
- Department of Gastroenterology and Hepatology, Indiana University Health, Indiana University School of Medicine, 550 University Boulevard, Indianapolis, IN 46202, USA
| | - Ramzi Mulki
- Department of Gastroenterology and Hepatology, University of Alabama, Heersink School of Medicine, 1720 university Boulevard, Birmingham, AL 35294, USA.
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Liman A, Koh L, Barakat M, Abu El Haija M. Preoperative esophagogastroduodenoscopy in pediatric bariatric surgery: A summary of the literature. JPGN REPORTS 2024; 5:243-249. [PMID: 39149187 PMCID: PMC11322023 DOI: 10.1002/jpr3.12095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 08/17/2024]
Abstract
Our objective was to summarize the available literature on the use of preoperative esophagogastroduodenoscopy (EGD) and its impact on management and/or postoperative outcomes in pediatric patients undergoing metabolic and bariatric surgery. We performed a search using PubMed in February 2023 for articles examining EGD and any clinical correlation in pediatric patients undergoing bariatric surgery. Search results were manually reviewed and included in the study if they examined findings of EGD done prior to bariatric surgery and were excluded if they were not primarily done in pediatric or adolescent patients. Our search yielded 549 distinct articles, with a total of four articles remaining after applying inclusion and exclusion criteria. All four studies were retrospective. A total of 244 patients were studied, with an age range of 9-25 years. Of the patients whose respective findings were reported, 21/150 patients (14%) had esophagitis, 55/150 (37%) had gastritis, 55/244 (23%) had Helicobacter pylori, and 18/150 (12%) had duodenitis. There were a total of 60 findings that changed medical management, and one that changed surgical management. A high proportion of positive EGD findings that changed medical management was evident, and one study suggested that mucosal inflammation may be a prognostic indicator for postoperative weight loss. However, there is a paucity of data examining the utility of routine EGD prior to bariatric surgery, specifically in pediatric patients, and more studies are therefore needed to construct the evidence basis for guidelines.
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Affiliation(s)
- Andrew Liman
- Department of Pediatrics, School of MedicineDivision of Pediatric Gastroenterology, Hepatology & NutritionStanford UniversityStanfordCaliforniaUSA
| | - Linda Koh
- Department of Pediatrics, School of MedicineDivision of Pediatric Gastroenterology, Hepatology & NutritionStanford UniversityStanfordCaliforniaUSA
| | - Monique Barakat
- Department of Pediatrics, School of MedicineDivision of Pediatric Gastroenterology, Hepatology & NutritionStanford UniversityStanfordCaliforniaUSA
- Department of Internal Medicine, School of MedicineDivision of Gastroenterology and HepatologyStanfordCaliforniaUSA
| | - Marwa Abu El Haija
- Department of Pediatrics, School of MedicineDivision of Pediatric Gastroenterology, Hepatology & NutritionStanford UniversityStanfordCaliforniaUSA
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Felsenreich DM, Malzner A, Eichner M, Hoelbing E, Moosbrugger A, Beckerhinn P, Prager G, Brix JM, Itariu BK. [Indications and preoperative planning for bariatric surgery]. Wien Klin Wochenschr 2023; 135:721-728. [PMID: 37821695 PMCID: PMC10567874 DOI: 10.1007/s00508-023-02271-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 10/13/2023]
Abstract
These clinical practice guidelines represent the consensus opinion of a group of Austrian specialist physicians associated with the treatment of obesity. The recommendations incorporate the current literature and guidelines and aim to balance both procedural feasibility and patient acceptance and adherence. Special emphasis was placed on simplification of the preoperative clarification and maximum patient safety. Therefore, this article makes no claim to be complete in all fields.
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Affiliation(s)
- Daniel Moritz Felsenreich
- Klinische Abteilung für Viszeralchirurgie, Universitätsklinik für Allgemeinchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Andrea Malzner
- Abteilung für Innere Medizin I, Gastroenterologie und Hepatologie, Rheumatologie, Endokrinologie und Diabetologie, Klinikum Wels-Grieskirchen, Wels, Österreich
| | - Marlies Eichner
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Klinik Hietzing, Wien, Österreich
| | | | - Alexander Moosbrugger
- Abteilung für Innere Medizin II, Krankenhaus der Barmherzigen Brüder, Graz, Österreich
| | - Philipp Beckerhinn
- Abteilung für Chirurgie, Landesklinikum Hollabrunn, Hollabrunn, Österreich
| | - Gerhard Prager
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Johanna Maria Brix
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
- Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Bianca-Karla Itariu
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
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Vu AH, Chiang J, Qian Y, Tursunova N, Nha J, Ferzli G. Do all roads lead to Rome?: A retrospective analysis on surgical technique in Roux-en-Y gastric bypass. Surg Endosc 2023; 37:7254-7263. [PMID: 37415013 DOI: 10.1007/s00464-023-10257-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND New York University Langone Health has three accredited bariatric centers, with altogether ten different bariatric surgeons. This retrospective analysis compares individual surgeon techniques in laparoscopic or robotic Roux-en-Y gastric bypass (RYGB) to identify potential associations with perioperative morbidity and mortality. METHODS All adult patients who underwent RYGB between 2017 and 2021 at NYU Langone Health campuses were evaluated via electronic medical records and MBSAQIP 30-day follow-up data. We surveyed all ten practicing bariatric surgeons to analyze the relationship between their techniques and total adverse outcomes. Bleeding, SSI, mortality, readmission, and reoperation were specifically sub-analyzed via logistic regression. RESULTS 54 (7.59%) out of 711 patients who underwent laparoscopic or robotic RYGB encountered an adverse outcome. Lower adverse outcomes were observed with laparoscopic approach, creating the JJ anastomosis first, flat positioning, division of the mesentery, Covidien™ laparoscopic staplers, gold staples, unidirectional JJ anastomosis, hand-sewn common enterotomy, 100-cm Roux limb, 50-cm biliopancreatic limb, and routine EGD. Lower bleeding rates were observed with flat positioning, gold staples, hand-sewn common enterotomy, 50-cm biliopancreatic limb, and routine EGD. Lower readmission rates were observed in laparoscopic, flat positioning, Covidien™ staplers, unidirectional JJ anastomosis, and hand-sewn common enterotomy. Gold staples had lower reoperation rates. Otherwise, there was no statistically significant difference in SSI. CONCLUSION Certain surgical techniques in RYGB within our bariatric surgery group had significant effects on the rates of total adverse outcomes, bleeding, readmission, and reoperation. Our findings warrant further investigation into the aforementioned techniques via multivariate regression models or prospective study design. LIMITATIONS This study was limited by the inherent nature of its retrospective and univariate statistical design. We did not account for the interaction between techniques. The sample size of surgeons was small, and follow-up of 30 days was relatively short. We did not include patient characteristics in the model or control for surgeon skill.
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Affiliation(s)
- Alexander Hien Vu
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA.
| | - Jessica Chiang
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA
| | - Yunzhi Qian
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Nilufar Tursunova
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA
| | - Jaein Nha
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA
| | - George Ferzli
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA.
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Muir D, Choi B, Holden M, Clements C, Stevens J, Ratnasingham K, Irukulla S, Humadi S. Preoperative Oesophagogastroduodenoscopy and the Effect on Bariatric Surgery: a Systematic Review and Meta-Analysis. Obes Surg 2023; 33:2546-2556. [PMID: 37314649 DOI: 10.1007/s11695-023-06680-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Abstract
Preoperative oesophagogastroduodenoscopy (OGD) in bariatric surgery remains a controversial topic, with a large variety in practice globally. An electronic database search of Medline, Embase and PubMed was performed in an aim to categorise the findings of preoperative endoscopies in bariatric patients. A total of 47 studies were included in this meta-analysis resulting in 23,368 patients being assessed. Of patients assessed, 40.8% were found to have no novel findings, 39.7% had novel findings which did not affect surgical planning, 19.8% had findings that affected their surgery and 0.3% were ruled to not be suitable for bariatric surgery. Preoperative OGD is altering surgical planning in one-fifth of patients; however, further comparative studies are required to determine if each patient should undergo this procedure especially if asymptomatic.
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Affiliation(s)
- Duncan Muir
- Ashford and St Peter's Hospitals NHS Trust, Chertsey, UK.
| | - Byung Choi
- Ashford and St Peter's Hospitals NHS Trust, Chertsey, UK
| | - Matthew Holden
- Maxwell Institute, University of Edinburgh and Heriot-Watt University, Edinburgh, UK
| | | | | | | | | | - Samer Humadi
- Ashford and St Peter's Hospitals NHS Trust, Chertsey, UK
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7
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Sawathanon S, Promchan D, Thongwong M, Wangkulangkul P, Cheewatanakornkul S, Keeratichananont S, Yolsuriyanwong K. Impact of preoperative esophagogastroduodenoscopy in patients undergoing bariatric surgery and development of a model to predict clinically significant abnormal endoscopic findings. Surg Endosc 2023; 37:2202-2208. [PMID: 35864356 PMCID: PMC9302948 DOI: 10.1007/s00464-022-09391-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preoperative esophagogastroduodenoscopy (EGD) in patients undergoing bariatric surgery can help surgeons detect abnormalities in the upper gastrointestinal (UGI) tract that may require a change in surgical plan. However, the need for EGD before bariatric surgery is controversial. OBJECTIVES We aimed to determine the prevalence of UGI abnormalities and evaluate the predictive factors of abnormal findings that require a change in surgical plan or cause a delay in surgical treatment in patients undergoing bariatric surgery and develop a prediction model. METHODS The medical records from January 2012 to July 2020 were retrospectively reviewed in patients who underwent EGD before bariatric surgery. The EGD findings were classified into four groups based on their effects on management. Group 1 had normal findings. Group 2 had abnormal findings that did not require a change in surgical management. Group 3 had abnormal findings that required a change in the surgical plan or caused a delay in surgical treatment. Group 4 had contraindications to surgery. Predictive factors for Groups 3 and 4 were analyzed using univariate and multivariate analyses. A model visualized as a nomogram was developed based on significant factors. Discrimination and calibration were evaluated. RESULTS A total of 461 patient records (63.8% female) were reviewed. The mean age was 35.1 ± 11.2 years and the mean BMI was 47.7 ± 8.7 kg/m2. The prevalence of endoscopic findings in Groups 1, 2, 3, and 4 were 42.5%, 35.6%, 21.9%, and 0%, respectively. The most common abnormal findings were non-erosive gastritis (31.2%) followed by Helicobacter pylori infection (18.7%) and hiatal hernia (10.2%). Male sex and NSAID use were significantly associated with detection of lesions in Group 3 either on univariate or multivariate analysis, while type 2 diabetes mellitus (T2DM) was a significant protective factor on multivariate analysis. On subgroup analysis in patients ≥ 40 years old, multivariate analysis revealed age, BMI, and NSAID use were significantly associated with the detection of lesions in Group 3, while T2DM was still a significant protective factor. A nomogram to predict lesions in Group 3 for this subgroup was developed and showed good discrimination (C-statistics 0.737, 95% CI 0.721‒0.752). CONCLUSION A high prevalence of abnormal endoscopic findings was observed in Thai patients who are undergoing bariatric surgery. Preoperative EGD screening is helpful in detecting UGI abnormalities that require a change in the surgical decision plan. The new nomogram may help rational utilization of EGD prior to bariatric surgery.
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Affiliation(s)
- Surawitch Sawathanon
- Songklanagarind Excellence Center for Obesity and Metabolic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand
| | - Darawan Promchan
- Nursing Service Division, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand
| | - Meena Thongwong
- Nursing Service Division, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand
| | - Piyanun Wangkulangkul
- Songklanagarind Excellence Center for Obesity and Metabolic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand
| | - Siripong Cheewatanakornkul
- Songklanagarind Excellence Center for Obesity and Metabolic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand
| | - Suriya Keeratichananont
- Nanthana-Kriengkrai Chotiwatanaphan Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand
| | - Kamthorn Yolsuriyanwong
- Songklanagarind Excellence Center for Obesity and Metabolic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand
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8
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Felsenreich DM, Arnoldner MA, Wintersteller L, Mrekva A, Jedamzik J, Eichelter J, Langer FB, Prager G. Intrathoracic pouch migration in one-anastomosis gastric bypass with and without hiatoplasty: A 3-dimensional-computed tomography volumetry study. Surg Obes Relat Dis 2022; 19:492-499. [PMID: 36566133 DOI: 10.1016/j.soard.2022.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/14/2022] [Accepted: 11/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Currently, 4.8% of bariatric operations worldwide are one-anastomosis gastric bypass (OAGB) procedures. If a hiatal hernia is detected in a preoperative gastroscopy, OAGB can be combined with hiatoplasty. Intrathoracic pouch migration (ITM) is common after bypass procedures because the fundus, a natural abutment, is separated from the pouch. OBJECTIVE The aim of this study was to find out whether OAGB or OAGB combined with hiatoplasty carries a higher risk of ITM and, therefore, also gastroesophageal reflux disease (GERD). SETTING University hospital. METHODS Fifty patients (group 1: 25× primary OAGB; group 2: 25× primary OAGB with hiatoplasty) were included in this study. History of weight, GERD, and quality of life were recorded in patient interviews and pouch volume and ITM were evaluated using 3-dimensional-computed tomography volumetry. RESULTS There were no differences in terms of patient characteristics, history of weight, pouch volume, or quality of life between both groups. ITM was found in group 1 in 60% (n = 15) and group 2 in 76% (n = 19) of all patients (P = .152). The ITM mean length was significantly lower in group 1 with .9 ± 1.1 cm than in group 2 with 1.8 ± 1.2 cm (P = .007). Regarding GERD, there was no difference between both groups; nevertheless, significantly more patients with ITM (38.2%; n = 13) had GERD compared with patients without ITM (6.3%; n = 1). CONCLUSION In primary OAGB, an additional hiatoplasty was not associated with higher rates of ITM or GERD; nevertheless, the length of ITM was higher after hiatoplasty. If ITM occurs, patients have a risk of developing GERD.
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Affiliation(s)
- Daniel M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael A Arnoldner
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lukas Wintersteller
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Arpad Mrekva
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Julia Jedamzik
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Jakob Eichelter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Felix B Langer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
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Gastrointestinal Symptomatology as a Predictor of Esophagogastroduodenoscopy Findings in the Bariatric Population: a Retrospective Cohort Study with Review of the Literature. Obes Surg 2022; 32:2417-2425. [DOI: 10.1007/s11695-022-06099-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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Lewit RA, Jancelewicz T, Cavender CP, Smith W, Gray E, Burton ET, Weatherall YZ. Prevalence of Upper Gastrointestinal Inflammation in Teens With Obesity Prior to Sleeve Gastrectomy. J Surg Res 2022; 273:119-126. [DOI: 10.1016/j.jss.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/23/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
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Predictive Factors for Developing GERD After Sleeve Gastrectomy: Is Preoperative Endoscopy Necessary? J Gastrointest Surg 2022; 26:1015-1020. [PMID: 34997468 DOI: 10.1007/s11605-021-05207-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/16/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is the most common bariatric procedure performed in the USA. There is a concern for new gastroesophageal reflux disease (GERD) and Barrett's esophagus after SG. Endoscopic screening before bariatric surgery is controversial. We sought to identify preoperative endoscopic factors that may predict the development of GERD after SG. METHODS We prospectively evaluated 217 patients undergoing primary robotic-assisted SG. All patients underwent endoscopy before SG and for-cause postoperatively. Patients were followed for the development of GERD, diagnosed by either biopsy-proven reflux esophagitis or a positive esophageal pH test. Patients were separated into 2 groups: Those who developed GERD after surgery (GERD group) and those who did not (No GERD group). Patients with a positive preoperative pH test, LA Grade B or greater esophagitis, or hiatal hernia > 5 cm on preoperative endoscopy were counseled to undergo gastric bypass and excluded. RESULTS There were more males in the No GERD group (25.6% vs. 8.1%; p = 0.02). More patients had preoperative heartburn symptoms in the GERD group (40.5% vs. 23.9%; p = 0.04). Endoscopically identified esophagitis was more common in the GERD group (29.7% vs. 13.3%; p = 0.01), as was biopsy-proven esophagitis (24.3% vs. 11.1%; p = 0.03). There was no significant difference in the incidence or size of hiatal hernia or in the rate of H. pylori infection between the groups. On multivariate analysis, the strongest predictors of GERD after SG were endoscopically identified esophagitis (odds ratio [OR] 2.79; 95% confidence interval [CI]1.17-6.69; p = 0.02) and biopsy-proven esophagitis (OR 2.80; 95% CI 1.06-7.37; p = 0.04). Male patients were less likely to develop GERD after SG (OR 0.23; 95% CI 0.06-0.85; p = 0.03). CONCLUSION Our findings strengthen the rationale for routine preoperative endoscopy and highlight critical clinical and endoscopic criteria that should prompt consideration of alternatives to SG for weight loss.
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12
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Kanat BH, Doğan S. Is gastroscopy necessary before bariatric surgery? World J Gastrointest Endosc 2022; 14:29-34. [PMID: 35116097 PMCID: PMC8788171 DOI: 10.4253/wjge.v14.i1.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/26/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023] Open
Abstract
Obesity is the abnormal accumulation of fat or adipose tissue in the body. It has become a serious health problem in the world in the last 50 years and is considered a pandemic. Body mass index is a widely used classification. Thus, obese individuals can be easily classified and standardized. Obesity is the second cause of preventable deaths after smoking. Obesity significantly increases mortality and morbidity. We thought of preparing a publication about routine procedures for the preoperative evaluation of obesity. The question that we asked as bariatric and metabolic surgeons but which was not exactly answered in the literature was "Is esophagogastroduodenoscopy (EGD) necessary before bariatric surgery?" We found different answers in our literature review. The European Association of Endoscopic Surgery guidelines recommend EGD for all bariatric procedures. They strongly recommend it for Roux-en-Y gastric bypass (RYGB). As a result of a recent study by the members of the British Obesity & Metabolic Surgery Society, preoperative EGD is routinely recommended for patients undergoing sleeve gastrectomy, even if they are asymptomatic, but not recommended for RYGB. It is recommended for symptomatic patients scheduled for RYGB. According to the International Sleeve Gastrectomy Expert Panel Consensus Statement, preoperative EGD is definitely recommended for patients scheduled for sleeve gastrectomy, but its routine use for RYGB is controversial. However, a different view is that the American Society for Gastrointestinal Endoscopy recommends endoscopy only for symptomatic patients scheduled for bariatric surgery. In the literature, the primary goal of EGD recommended for sleeve gastrectomy has been interpreted as determining esophagitis caused by gastroesophageal reflux. In the light of the literature, it is stated that this procedure is not necessary in America, while it is routinely recommended in the European continent. Considering medicolegal cases that may occur in the future, we are in favor of performing EGD before bariatric surgery. In conclusion, EGD before bariatric surgery is insurance for both patients and physicians. There is a need for larger and prospective studies to reach more precise conclusions on the subject.
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Affiliation(s)
- Burhan Hakan Kanat
- Department of General Surgery, Malatya Turgut Özal University, School of Medicine, Malatya 44100, Turkey
| | - Serhat Doğan
- Department of General Surgery, Malatya Turgut Özal University, School of Medicine, Malatya 44100, Turkey
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13
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Impact of Gastropexy/Omentopexy on Gastrointestinal Symptoms after Laparoscopic Sleeve Gastrectomy. Obes Surg 2021; 32:729-736. [PMID: 34870791 PMCID: PMC8866353 DOI: 10.1007/s11695-021-05806-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 11/15/2022]
Abstract
Background Laparoscopic sleeve gastrectomy (LSG) has become a single-step operation for the management of severe obesity. A statistically significant number of participants who undergo this procedure experience nausea, vomiting, and reflux symptoms early after the operation. The objectives of this study were to measure the positive or negative effect of gastropexy on reducing distressing postoperative LSG-related gastrointestinal symptoms. Patients and Methods This was a comparative randomized study conducted from January 2018 to January 2021. The study was carried out in the general surgery department at Menoufia University Hospital, Menoufia Faculty of Medicine in Egypt. Two hundred participants were included randomly during this trial. The participants were divided into two groups, with 100 patients in each group. Patients in group A underwent gastropexy, and patients in group B underwent LSG without gastropexy. Results There was no significant difference between the groups in age or sex (p > 0.05). There was no significant difference in the length of hospital stay (p > 0.05). There was a significant difference between the two groups regarding nausea, vomiting, reflux symptoms, and the amount and frequency of antiemetics used (p < 0.001). There was also a significant difference in hospital readmissions (p < 0.05) and in clinic visits during the postoperative period. Conclusions Patients who underwent gastropexy showed a significant reduction in antiemetic consumption and a significantly lower incidence of postoperative nausea, vomiting, gastroesophageal reflux disease symptoms and gastric torsion than those who did not undergo gastropexy. Graphical abstract ![]()
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Controversies in the Preoperative Workup and Management for Patients Undergoing Bariatric Surgery: A Review of the Literature. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Role of Preoperative Esophagogastroduodenoscopy (EGD) in Bariatric Treatment. J Clin Med 2021; 10:jcm10132982. [PMID: 34279468 PMCID: PMC8267643 DOI: 10.3390/jcm10132982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The recommendations for routine preoperative esophagogastroduodenoscopy (EGD) in patients qualified for bariatric surgeries are still a matter of debate. The aim of this study was to analyze the pathologies on preoperative EGD in patients qualified for bariatric surgeries. Materials and Methods: This study included 222 patients, divided into two groups. The obesity group consisted of patients with obesity (BMI ≥ 40 kg/m2), for whom EGD was a routine part of the preparation for laparoscopic sleeve gastrectomy (LSG). The control group of patients with normal body weight (BMI) qualified for EGD because of gastrointestinal ailments. Results: Regarding preoperative EGD in patients qualified for bariatric surgeries, we analyzed the prevalence of endoscopic pathologies in various gastrointestinal tract segments. Patients with obesity were shown to present with esophageal pathologies significantly more often than persons in the control group (n = 23, 20.91% vs. n = 12, 10.91%, p = 0.042). The odds ratio of esophageal pathologies in patients with obesity versus the control group equaled 2.15 (95%CI: 1.01–4.59). In turn, the odds ratio of duodenal pathologies in patients from the control group was 3.31 (95%Cl: 1.16–9.47), which means that persons from this group were approximately three times more likely to be diagnosed with those pathologies compared to obese patients. Moreover, patient sex was a significant predictor of duodenal pathologies, with an odds ratio of 4.03 (95%CI: 1.53–10.61). Conclusions: Preoperative EGD can identify a broad spectrum of pathologies in obese patients, which suggests a routine examination before bariatric surgery.
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IFSO Position Statement on the Role of Esophago-Gastro-Duodenal Endoscopy Prior to and after Bariatric and Metabolic Surgery Procedures. Obes Surg 2021; 30:3135-3153. [PMID: 32472360 DOI: 10.1007/s11695-020-04720-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
One of the roles of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) is to provide guidance on the management of patients seeking surgery for adiposity-based chronic diseases. The role of endoscopy around the time of endoscopy is an area of clinical controversy. In 2018, IFSO commissioned a task force to determine the role of endoscopy before and after surgery for the management of adiposity and adiposity-based chronic diseases. The following position statement is issued by the IFSO Endoscopy in Bariatric/Metabolic Surgery Taskforce. It has been approved by the IFSO Scientific Committee and Executive Board. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence. It will be reviewed regularly.
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ASMBS position statement on the rationale for performance of upper gastrointestinal endoscopy before and after metabolic and bariatric surgery. Surg Obes Relat Dis 2021; 17:837-847. [PMID: 33875361 DOI: 10.1016/j.soard.2021.03.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/13/2021] [Indexed: 12/18/2022]
Abstract
The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to inquiries made to the Society by patients, physicians, society members, hospitals, health insurance payors, the media, and others regarding the need and possible strategies for screening endoscopic examination before metabolic and bariatric surgery (MBS), as well as the rationale, indications, and strategies for postoperative surveillance for mucosal abnormalities, including gastroesophageal reflux disease and associated esophageal mucosal injuries (erosive esophagitis and Barrett's esophagus) that may develop in the long term after MBS, specifically for patients undergoing sleeve gastrectomy or Roux-en-Y gastric bypass. The general principles described here may also apply to procedures such as biliopancreatic diversion (BPD) and BPD with duodenal switch (DS); however, the paucity of procedure-specific literature for BPD and DS limits the value of this statement to those procedures. In addition, children with obesity undergoing MBS may have unique considerations and are not specifically addressed in this position statement. This recommendation is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement is not intended to be and should not be construed as stating or establishing a local, regional, or national standard of care. The statement will be revised in the future as additional evidence becomes available.
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Fisher OM, Chan DL, Talbot ML, Ramos A, Bashir A, Herrera MF, Himpens J, Shikora S, Higa KD, Kow L, Brown WA. Barrett's Oesophagus and Bariatric/Metabolic Surgery-IFSO 2020 Position Statement. Obes Surg 2021; 31:915-934. [PMID: 33460005 DOI: 10.1007/s11695-020-05143-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/07/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022]
Abstract
The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has been playing an integral role in educating both the metabolic surgical and the medical community at large about the importance of surgical and/or endoscopic interventions in treating adiposity-based chronic diseases. The occurrence of chronic conditions following bariatric/metabolic surgery (BMS), such as gastro-oesophageal reflux disease (GERD) and columnar (intestinal) epithelial metaplasia of the distal oesophagus (also known as Barrett's oesophagus (BE)), has long been discussed in the metabolic surgical and medical community. Equally, the risk of neoplastic progression of Barrett's oesophagus to oesophageal adenocarcinoma (EAC) and the resulting requirement for surgery are the source of some concern for many involved in the care of these patients, as the surgical alteration of the gastrointestinal tract may lead to impaired reconstructive options. As such, there is a requirement for guidance of the community.The IFSO commissioned a task force to elucidate three aspects of the presenting problem: First, to determine what the estimated incidence of Barrett's oesophagus is in patients presenting for BMS; second, to determine the frequency at which Barrett's oesophagus may develop following BMS (with a particular focus on the laparoscopic sleeve gastrectomy (LSG)); and third, to determine if regression of Barrett's oesophagus may occur following BMS given the close relationship of obesity and the development of BE/EAC. Based on these findings, a position statement regarding the management of this pathology in the context of BMS was developed. The following position statement is issued by the IFSO Barrett's Oesophagus task force andapproved by the IFSO Scientific Committee and Executive Board. This statement is based on current clinical knowledge, expert opinion and published peer-reviewed scientific evidence. It will be reviewed regularly.
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Affiliation(s)
- Oliver M Fisher
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Daniel L Chan
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Michael L Talbot
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Almino Ramos
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Ahmad Bashir
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Miguel F Herrera
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Jacques Himpens
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Scott Shikora
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Kelvin D Higa
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Lilian Kow
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Wendy A Brown
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy. .,Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia.
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20
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Makiewicz K, Berbiglia L, Douglas D, Bohon A, Zografakis J, Dan A. Prevalence of Upper Gastrointestinal Pathology in Patients with Obesity on Preoperative Endoscopy. JSLS 2020; 24:JSLS.2020.00021. [PMID: 32612344 PMCID: PMC7316525 DOI: 10.4293/jsls.2020.00021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background and Objectives: The preoperative work up for bariatric surgery is variable and not all centers perform a preoperative upper gastrointestinal endoscopy. A study was undertaken to determine the frequency of clinically significant gross endoscopic and pathological diagnoses in a large sample of patients with obesity undergoing work-up for bariatric surgery. Methods: Routine endoscopy was performed on all preoperative bariatric patients. A retrospective chart review of 1000 consecutive patients was performed. Patients were divided into three groups: Group A (no endoscopic findings), Group B (clinically insignificant findings), Group C (clinically significant findings). Results: Patients had a mean body mass index (BMI) of 49 kg/m2 and 79% were female. In this sample one finding was found on preoperative EGD in 95.2% of patients, 33.9% had at least two diagnoses, and 29.9% had three or more diagnoses. Group A (no findings) consisted of 4.8% of patient, 52.5% in Group B (clinically insignificant findings), and 42.7% were in Group C (clinically significant findings). Clinically significant findings included hiatal hernia 23.5%, esophagitis 9.5%, H. pylori 7.1%, gastric erosions 5.7%, duodenitis 3.7%, Barrett's esophagus 3.1%, and Schatzki ring 1.2%. There was no significant correlation between preoperative BMI and any endoscopic findings (all p-value 0.05). Patients in Group C were statistically older than Groups A and B. Conclusion: Upper gastrointestinal pathology is highly common in patients with obesity. There is a significant rate of clinically significant endoscopy findings and all bariatric surgery patients should undergo preoperative endoscopy.
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Affiliation(s)
| | | | | | - Ashley Bohon
- Summa Health, Akron City Hospital, Akron, OH, USA
| | | | - Adrian Dan
- Summa Health, Akron City Hospital, Akron, OH, USA
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Fernández JA, Frutos MD, Ruiz-Manzanera JJ. Incidental Gastrointestinal Stromal Tumors (GISTs) and Bariatric Surgery: A Review. Obes Surg 2020; 30:4529-4541. [PMID: 32710370 DOI: 10.1007/s11695-020-04853-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/20/2022]
Abstract
The number of bariatric procedures has increased notably, with incidental findings such as gastrointestinal stromal tumors (GISTs) being observed in 2%. The number of studies dealing with incidental findings during bariatric surgery (BS), especially GISTs, is scarce. This review aims to summarize the evidence about GIST diagnosis during BS, and to establish recommendations for the management and follow-up of these patients. A systematic literature search from January 2000 to March 2020 was performed. Retrospective cohort studies, case series, case reports, reviews, and conference abstracts were considered eligible. The present systematic review focused on a descriptive analysis of the data included in the articles selected. The calculated incidence was 0.65%. A change in operative plan was observed in 5% of the cases. In 98% of the cases, GISTs were gastric, with a mean size of 10.3 mm. The mitotic index was < 5 in 99%. Accordingly, all patients were classified as having a very low or low risk of recurrence. R0 resection was achieved in 100% of cases. The incidence of GISTs in patients with MO submitted to BS is considerably higher than in the general population. The diagnosis is related to the depth of preoperative work, the exhaustiveness of the intraoperative examination, and the meticulousness of the histopathological analysis. Although GISTs have a low risk of recurrence and it was previously unnecessary to modify the surgical technique, we recommend that bariatric surgeons are aware of the diagnosis and management of incidental GISTs.
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Affiliation(s)
- J A Fernández
- Sarcoma and Mesenchymal Tumors Unit, General Surgery Service, "La Arrixaca" Clinical University Hospital, Murcia, Spain.
| | - M D Frutos
- Bariatric Surgery Unit, General Surgery Service, "La Arrixaca" Clinical University Hospital, Murcia, Spain
| | - J J Ruiz-Manzanera
- General Surgery Service, "La Arrixaca" Clinical University Hospital, Murcia, Spain
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22
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Ooi GJ, Browning A, Hii MW, Read M. Perioperative screening, management, and surveillance of Barrett's esophagus in bariatric surgical patients. Ann N Y Acad Sci 2020; 1481:224-235. [PMID: 32794237 DOI: 10.1111/nyas.14441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/06/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022]
Abstract
Obesity is a strong risk factor for Barrett's esophagus (BE), the only proven precursor lesion to esophageal adenocarcinoma (EAC). Bariatric surgery is currently the only reliable treatment that achieves long-term sustained weight loss; however, it can markedly affect the development of de novo BE, and the progression or regression of existing BE. Bariatric procedures may also have implications on future surgical management of any consequent EAC. In this review, we examine the current evidence and published guidelines for BE in bariatric surgery. Current screening practices before bariatric surgery vary substantially, with conflicting recommendations from bariatric societies. If diagnosed, the presence of BE may alter the type of bariatric procedure. A selective screening approach prevents unnecessary endoscopy; however, there is poor symptom correlation with disease. Studies suggest that sleeve gastrectomy predisposes patients to gastroesophageal reflux and de novo BE. Conversely, Roux-en-Y gastric bypass is associated with decreased reflux and potential improvement or resolution of BE. There are currently no guidelines addressing the surveillance for BE following bariatric surgery. BE is an important consideration in the management of bariatric surgical patients. Evidence-based recommendations are required to guide procedure selection and postoperative surveillance.
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Affiliation(s)
- Geraldine J Ooi
- Department of Surgery, Central Clinical School, Monash University, Prahran, Victoria, Australia
| | - Alison Browning
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Michael W Hii
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia.,Department of Surgery, the University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Matthew Read
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia.,Department of Surgery, the University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia
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Prevalence of Endoscopic Findings Before Bariatric Surgery and Their Influence on the Selection of the Surgical Technique. Obes Surg 2020; 30:4375-4380. [PMID: 32588172 DOI: 10.1007/s11695-020-04800-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most popular procedures performed. The decision of which technique is most appropriate depends on the surgeon's preferences and experience. However, several factors strongly influence the decision of the procedure performed, including gastrointestinal disorders or asymptomatic upper gastrointestinal endoscopy (UGE) findings. This study aimed to describe the pathological endoscopic findings in morbidly obese patients undergoing preoperative routine UGE. MATERIALS AND METHODS A retrospective review of a prospectively collected database of all UGEs performed before bariatric surgery was performed. UGE was routinely performed to all the patients as part of the preoperative evaluation protocol. RESULTS A total of 790 patients were included. Surgical technique included 610 (77.2%) RYGB and 180 (22.8%) SG. Twenty-one asymptomatic patients presented esophagitis at UGE. In only seven patients (0.89%), the endoscopic findings of esophagitis had changed the initial surgical decision. The presence of ulcers or adenomatous or incompletely resected polyps was an indication for SG, to assure future endoscopic access in case it is needed. In 25 patients (3.17%), the initial operation would have been changed based on UGE findings. CONCLUSION Preoperative UGE allows the diagnosis of asymptomatic esophagitis related to gastroesophageal reflux disease and the identification of asymptomatic polyps and ulcers, with the potential ability for malignant transformation. In up to 3.17% of the cases, the endoscopic findings changed the operative strategy. As the complication rate associated with the procedure is low, we recommend the routine performance of preoperative UGE before bariatric surgery.
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24
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Assalia A, Gagner M, Nedelcu M, Ramos AC, Nocca D. Gastroesophageal Reflux and Laparoscopic Sleeve Gastrectomy: Results of the First International Consensus Conference. Obes Surg 2020; 30:3695-3705. [PMID: 32533520 DOI: 10.1007/s11695-020-04749-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is probably the main drawback of laparoscopic sleeve gastrectomy (LSG). Herein, we critically discuss the issue and report the results of the first international consensus conference held in Montpellier, France, during June 2019. METHODS Fifty international bariatric experts from 25 countries convened for 2 days for interactive discussions, and to formulate the most relevant questions by electronically submitting 55 preliminary questions to panelists. Following the meeting, a final drafted questionnaire comprised of 41 questions was sent to all experts via e-mail. RESULTS Forty-six experts responded (92%). Esophago-gastro-duodenoscopy was considered mandatory before (92%) and after (78%) surgery. No consensus was achieved as to time intervals after surgery and the role of specialized tests for GERD. Higher degrees of erosive esophagitis (94%) and Barrett's esophagus (96%) were viewed as contra-indications for LSG. Roux-en-Y gastric bypass was recommended in postoperative patients with uncontrolled GERD and insufficient (84%) or sufficient (76%) weight loss and Barrett's esophagus (78%). Hiatal hernia (HH) repair was deemed necessary even in asymptomatic patients without GERD (80% for large and 67% for small HH). LSG with fundoplication in patients with GERD was considered by 77.3% of panelists. CONCLUSIONS The importance of pre- and postoperative endoscopy has been emphasized. The role of specialized tests for GERD and the exact surveillance programs need to be further defined. LSG is viewed as contra-indicated in higher degrees of endoscopic and clinical GERD. LSG with anti-reflux fundoplication emerges as a new valid option in patients with GERD.
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Affiliation(s)
- Ahmad Assalia
- Division of Advanced Laparoscopic and Bariatric Surgery, Department of General Surgery, Rambam Health Care Campus and the Technion Faculty of Medicine, 8 Haalia str, 3109601, Haifa, Israel.
| | - Michel Gagner
- Hôpital du Sacre Coeur, Montreal, Canada.,Herbert Wertheim School of Medicine, Miami, FL, USA
| | - Marius Nedelcu
- Centre de Chirurgie de l'Obesite (CCO), Clinique Bouchard, Marseille, France.,Centre de Chirurgie de l'Obesite (CCO), Clinique Saint Michel, Toulon, France
| | - Almino C Ramos
- Gastro-Obeso-Center Institute for Metabolic Optimization, Sao Paulo, Brazil
| | - David Nocca
- Bariatric Unit, CHU Montpellier, Institut de génomique fonctionnelle, CNRS, INSERM, University of Montpellier, Montpellier, France
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25
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Landin M, Sudan R. This Is How We Do It: Laparoscopic Roux-en-Y Gastric Bypass. J Laparoendosc Adv Surg Tech A 2020; 30:619-622. [DOI: 10.1089/lap.2020.0155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- MacKenzie Landin
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Ranjan Sudan
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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High Cost for Low Yield: A Systematic Review and Meta-Analysis to Assess Cost of Routine Preoperative Esophagogastroduodenoscopy Before Bariatric Surgery. J Clin Gastroenterol 2020; 54:398-404. [PMID: 32168132 DOI: 10.1097/mcg.0000000000001334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Routine esophagogastroduodenoscopy (EGD) is an area of continued controversy in the preoperative evaluation for bariatric surgery; more information is needed regarding its impact on surgical management and associated costs. This systematic review and meta-analysis reports rates of abnormalities detected on preoperative EGD that changed operative management or delayed bariatric surgery. Sensitivity analysis examined the impact of controversial findings of hiatal hernia, Helicobacter pylori, gastritis, peptic ulcer disease. Data were used to calculate the cost per surgical alteration made due to abnormalities detected by routine EGD, compactly termed "cost-of-routine-EGD." Thirty-one retrospective observational studies were included. Meta-analysis found 3.9% of EGDs resulted in a change in operative management; this proportion decreased to 0.3% after sensitivity analysis, as detection of hiatal hernia comprised 85.7% of findings that changed operative management. Half of the 7.5% of cases that resulted in surgical delay involved endoscopic detection of H. pylori. Gastric pathology was detected in a significantly greater proportion of symptomatic patients (65.0%) than in asymptomatic patients (34.1%; P<0.001). Cost-of-routine-EGD to identify an abnormality that changed operative management was $601,060, after excluding controversial findings. The cost-of-routine-EGD to identify any abnormality that led to a change in type of bariatric operation was $281,230 and $766,352 when controversial findings were included versus excluded, respectively. Cost-of-routine-EGD to identify a malignancy was $2,554,506. Cost-of-routine-EGD is high relative to the low proportion of abnormalities that alter bariatric surgery. Our results highlight the need to develop alternative strategies to preoperative screening, in order to improve access and decrease cost associated with bariatric surgery.
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Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring) 2020; 28:O1-O58. [PMID: 32202076 DOI: 10.1002/oby.22719] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. METHODS Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.
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Affiliation(s)
- Jeffrey I Mechanick
- Guideline Task Force Chair (AACE); Professor of Medicine, Medical Director, Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart; Director, Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York; Past President, AACE and ACE
| | - Caroline Apovian
- Guideline Task Force Co-Chair (TOS); Professor of Medicine and Director, Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Stacy Brethauer
- Guideline Task Force Co-Chair (ASMBS); Professor of Surgery, Vice Chair of Surgery, Quality and Patient Safety; Medical Director, Supply Chain Management, Ohio State University, Columbus, Ohio
| | - W Timothy Garvey
- Guideline Task Force Co-Chair (AACE); Butterworth Professor, Department of Nutrition Sciences, GRECC Investigator and Staff Physician, Birmingham VAMC; Director, UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aaron M Joffe
- Guideline Task Force Co-Chair (ASA); Professor of Anesthesiology, Service Chief, Otolaryngology, Oral, Maxillofacial, and Urologic Surgeries, Associate Medical Director, Respiratory Care, University of Washington, Harborview Medical Center, Seattle, Washington
| | - Julie Kim
- Guideline Task Force Co-Chair (ASMBS); Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Robert F Kushner
- Guideline Task Force Co-Chair (TOS); Professor of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard Lindquist
- Guideline Task Force Co-Chair (OMA); Director, Medical Weight Management, Swedish Medical Center; Director, Medical Weight Management, Providence Health Services; Obesity Medicine Consultant, Seattle, Washington
| | - Rachel Pessah-Pollack
- Guideline Task Force Co-Chair (AACE); Clinical Associate Professor of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York
| | - Jennifer Seger
- Guideline Task Force Co-Chair (OMA); Adjunct Assistant Professor, Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas
| | - Richard D Urman
- Guideline Task Force Co-Chair (ASA); Associate Professor of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephanie Adams
- Writer (AACE); AACE Director of Clinical Practice Guidelines Development, Jacksonville, Florida
| | - John B Cleek
- Writer (TOS); Associate Professor, Department of Nutrition Sciences, University of Alabama, Birmingham, Alabama
| | - Riccardo Correa
- Technical Analysis (AACE); Assistant Professor of Medicine and Endocrinology, Diabetes and Metabolism Fellowship Director, University of Arizona College of Medicine, Phoenix, Arizona
| | - M Kathleen Figaro
- Technical Analysis (AACE); Board-certified Endocrinologist, Heartland Endocrine Group, Davenport, Iowa
| | - Karen Flanders
- Writer (ASMBS); Massachusetts General Hospital Weight Center, Boston, Massachusetts
| | - Jayleen Grams
- Writer (AACE); Associate Professor, Department of Surgery, University of Alabama at Birmingham; Staff Surgeon, Birmingham VA Medical Center, Birmingham, Alabama
| | - Daniel L Hurley
- Writer (AACE); Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Shanu Kothari
- Writer (ASMBS); Fellowship Director of MIS/Bariatric Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Michael V Seger
- Writer (OMA); Bariatric Medical Institute of Texas, San Antonio, Texas, Clinical Assistant Professor, University of Texas Health Science Center, Houston, Texas
| | - Christopher D Still
- Writer (TOS); Medical Director, Center for Nutrition and Weight Management Director, Geisinger Obesity Institute; Medical Director, Employee Wellness, Geisinger Health System, Danville, Pennsylvania
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Boerlage TCC, Wolvers PJD, Bruin SC, Huibregtse IL, Voermans RP, Fockens P, Hutten BA, Gerdes VEA. Upper endoscopy after Roux-en-Y gastric bypass: diagnostic yield and factors associated with relevant findings. Surg Obes Relat Dis 2020; 16:868-876. [PMID: 32299714 DOI: 10.1016/j.soard.2020.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/15/2020] [Accepted: 03/03/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND After laparoscopic Roux-en-Y gastric bypass many patients present with complaints for which an upper endoscopy is performed. However, often no abnormalities are found. OBJECTIVES To investigate the incidence of relevant findings at upper endoscopy and identify patient characteristics associated with a relevant finding. SETTING A high-volume bariatric center. METHODS A retrospective cohort study was performed. All patients presenting with complaints after laparoscopic Roux-en-Y gastric bypass who consequently underwent a diagnostic upper endoscopy were identified from a prospective endoscopic database. Primary outcomes were the number and type of relevant findings at upper endoscopy and its association with patient characteristics. Relevant findings were defined as abnormalities requiring treatment. RESULTS Ninety-eight (39.2%) of 250 patients had a relevant finding at upper endoscopy, mostly marginal ulcer and stomal stenosis. Male sex (odds ratio [OR] 3.47 [1.12-10.76]), alcohol consumption (OR 7.27 [1.58-33.36]), dysphagia or suspicion of bleeding as referral reason (OR 3.62 [1.54-8.52] and 39.93 [4.96-321.47], respectively, compared with abdominal pain), an abnormal upper gastrointestinal series (OR 6.81 [2.06-22.48]), and no abdominal ultrasound (OR 7.41 [1.48-37.08] compared with a normal ultrasound) were significantly associated with a relevant finding at upper endoscopy. CONCLUSIONS In this study sex, alcohol consumption, referral reason, and prior imaging studies were associated with a relevant finding at upper endoscopy after laparoscopic Roux-en-Y gastric bypass.
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Affiliation(s)
- Thomas C C Boerlage
- Department of Gastroenterology & Hepatology, St. Antonius Hospital, Utrecht, the Netherlands
| | - Paula J D Wolvers
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Sjoerd C Bruin
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Inge L Huibregtse
- Department of Gastroenterology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology & Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology & Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Barbara A Hutten
- Department of Clinical Epidemiology and Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Victor E A Gerdes
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Internal Medicine, Spaarne Gasthuis Hoofddorp, the Netherlands
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Santonicola A, Angrisani L, Vitiello A, Tolone S, Trudgill NJ, Ciacci C, Iovino P. Hiatal hernia diagnosis prospectively assessed in obese patients before bariatric surgery: accuracy of high-resolution manometry taking intraoperative diagnosis as reference standard. Surg Endosc 2020; 34:1150-1156. [PMID: 31139983 DOI: 10.1007/s00464-019-06865-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hiatal hernia (HH) is common in obese patients undergoing bariatric surgery. Preoperative traditional techniques such as upper gastrointestinal endoscopy (UGIE) or barium swallow/esophagram do not always correlate with intraoperative findings. High-resolution manometry (HRM) has shown a higher sensitivity and specificity than traditional techniques in non-obese patients in the HH diagnosis, whereas there is a lack of data in the morbidly obese population. We aimed to prospectively assess the diagnostic accuracy of HRM in HH detection, in comparison with barium swallow and UGIE, assuming intraoperative diagnosis as a standard of reference. METHODS Forty-one consecutive morbidly obese patients prospectively recruited from a tertiary-care referral hospital devoted to bariatric and metabolic surgery underwent a preoperative evaluation including standardized GERD questionnaires, barium swallow, UGIE, and HRM. The surgical procedures were performed by a single surgeon who was blinded to the results of other investigations. RESULTS HH was intraoperatively diagnosed in 11/41 patients (26.8%). In 10/11 patients, the preoperative HRM showed an esophagogastric junction suggestive of HH. When compared to intraoperative evaluation, the sensitivity of the HRM was 90.9% and the specificity 63.3%, with a positive predictive value of 47.6% and a negative predictive value of 95.0%. HRM showed a higher sensitivity and specificity compared to barium swallow and UGIE. CONCLUSIONS HRM has a high accuracy of HH detection in morbidly obese patients assuming an intraoperative diagnosis as reference standard. It could therefore be a very useful tool in the preoperative work-up of obese patients undergoing bariatric surgery.
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Affiliation(s)
- Antonella Santonicola
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Via S. Leonardo 1, 84131, Salerno, Italy
| | - Luigi Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - Antonio Vitiello
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - Salvatore Tolone
- Surgery Unit, Department of Surgery, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Nigel John Trudgill
- Department of Gastroenterology, Sandwell General Hospital, West Bromwich, Birmingham, UK
| | - Carolina Ciacci
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Via S. Leonardo 1, 84131, Salerno, Italy
| | - Paola Iovino
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Via S. Leonardo 1, 84131, Salerno, Italy.
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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.
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Våge V, Behme J, Jossart G, Andersen J. Gastropexy predicts lower use of acid-reducing medication after laparoscopic sleeve gastrectomy. A prospective cohort study. Int J Surg 2020; 74:113-117. [PMID: 31911216 DOI: 10.1016/j.ijsu.2019.12.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/11/2019] [Accepted: 12/24/2019] [Indexed: 01/30/2023]
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Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis 2019; 16:175-247. [PMID: 31917200 DOI: 10.1016/j.soard.2019.10.025] [Citation(s) in RCA: 303] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The development of these updated clinical practice guidelines (CPG) was commissioned by the American Association of Clinical Endocrinologists, The Obesity Society, the American Society of Metabolic and Bariatric Surgery, the Obesity Medicine Association, and the American Society of Anesthesiologists boards of directors in adherence to the American Association of Clinical Endocrinologists 2017 protocol for standardized production of CPG, algorithms, and checklists. METHODS Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS New or updated topics in this CPG include contextualization in an adiposity-based, chronic disease complications-centric model, nuance-based, and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current healthcare arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence-based within the context of a chronic disease. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
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Affiliation(s)
- Jeffrey I Mechanick
- Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, New York; Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Caroline Apovian
- Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | | | - W Timothy Garvey
- Department of Nutrition Sciences, Birmingham VA Medical Center, Birmingham, Alabama; UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aaron M Joffe
- University of Washington, Harborview Medical Center, Seattle, Washington
| | - Julie Kim
- Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Robert F Kushner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Rachel Pessah-Pollack
- Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York
| | - Jennifer Seger
- Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas
| | | | - Stephanie Adams
- American Association of Clinical Endocrinologists, Jacksonville, Florida
| | - John B Cleek
- Department of Nutrition Sciences, Birmingham VA Medical Center, Birmingham, Alabama
| | | | | | - Karen Flanders
- Massachusetts General Hospital Weight Center, Boston, Massachusetts
| | - Jayleen Grams
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Birmingham VA Medical Center, Birmingham, Alabama
| | - Daniel L Hurley
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | | | - Michael V Seger
- Bariatric Medical Institute of Texas, San Antonio, Texas, University of Texas Health Science Center, Houston, Texas
| | - Christopher D Still
- Center for Nutrition and Weight Management Director, Geisinger Obesity Institute, Danville, Pennsylvania; Employee Wellness, Geisinger Health System, Danville, Pennsylvania
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Mazahreh TS, Aleshawi AJ, Al-Zoubi NA, Allouh MZ, Jadallah KA, Elayyan R, Novotny NM. Preoperative esophagogastroduodenoscopy in patients without reflux symptoms undergoing laparoscopic sleeve gastrectomy: utility or futility? Clin Exp Gastroenterol 2019; 12:295-301. [PMID: 31456645 PMCID: PMC6620317 DOI: 10.2147/ceg.s216188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/12/2019] [Indexed: 12/12/2022] Open
Abstract
AIM To evaluate the value of esophagogastroduodenoscopy (EGD) as a preoperative investigation in individuals without symptoms of Gastro-Esophageal Reflux Disease (GERD) who will undergo laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS After Institutional Review Board approval was obtained, patients scheduled for LSG were prospectively enrolled in the study between January 2016 and March 2018. Patients with symptoms of GERD were excluded from the study. Participants were randomly allocated to two groups: individuals who underwent EGD before the surgery as a usual routine investigation (Group A), and individuals who were scheduled without preoperative EGD (Group B). Patient demographics, endoscopic findings, endoscopic biopsy results, and histopathological findings of the resected parts of the stomach after LSG were analyzed and recorded. Additionally, operative characteristics and outcomes, and follow up findings were recorded and analyzed with appropriate statistical methods. RESULTS A total of 219 individuals without symptoms of GERD underwent LSG were enrolled. Group A included 111 individuals (25 males and 86 females). Group B comprised 108 individuals (20 males and 88 females). The mean age and mean Body Mass Index (BMI) were similar in both groups. From Group A, 86 out of 111 individuals (77.5%) had no pathology identified on EGD, while 21 individuals (18.9%) were found to have areas of gastric erythema and biopsies showed active gastritis. All LSG operations were performed without any major complication. After one year, all individuals were assessed for the presence of symptomatic GERD and no significant difference was found between the two groups. CONCLUSION Preoperative EGD may not be mandatory for asymptomatic GERD individuals undergoing LSG as post-operative complications and early follow up for GERD symptoms are not significantly different. Further prospective studies with longer follow up are needed to evaluate the role of EGD in individuals undergoing LSG.
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Affiliation(s)
- Tagleb S Mazahreh
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid22110, Jordan
| | - Abdelwahab J Aleshawi
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid22110, Jordan
| | - Nabil A Al-Zoubi
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid22110, Jordan
| | - Mohammed Z Allouh
- Department of Anatomy, Faculty of Medicine, Jordan University of Science & Technology, Irbid22110, Jordan
- Department of Anatomy, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain17666, UAE
| | - Khaled A Jadallah
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid22110, Jordan
| | - Rasheed Elayyan
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid22110, Jordan
| | - Nathan M Novotny
- Department of Pediatric Surgery, Beaumont Children’s, Oakland University William Beaumont School of Medicine, Michigan48073, USA
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Santonicola A, Angrisani L, Vitiello A, Tolone S, Trudgill NJ, Ciacci C, Iovino P. Hiatal hernia diagnosis prospectively assessed in obese patients before bariatric surgery: accuracy of high-resolution manometry taking intraoperative diagnosis as reference standard. Surg Endosc 2019. [PMID: 31139983 DOI: 10.1007/s00464-019-06865-0.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND Hiatal hernia (HH) is common in obese patients undergoing bariatric surgery. Preoperative traditional techniques such as upper gastrointestinal endoscopy (UGIE) or barium swallow/esophagram do not always correlate with intraoperative findings. High-resolution manometry (HRM) has shown a higher sensitivity and specificity than traditional techniques in non-obese patients in the HH diagnosis, whereas there is a lack of data in the morbidly obese population. We aimed to prospectively assess the diagnostic accuracy of HRM in HH detection, in comparison with barium swallow and UGIE, assuming intraoperative diagnosis as a standard of reference. METHODS Forty-one consecutive morbidly obese patients prospectively recruited from a tertiary-care referral hospital devoted to bariatric and metabolic surgery underwent a preoperative evaluation including standardized GERD questionnaires, barium swallow, UGIE, and HRM. The surgical procedures were performed by a single surgeon who was blinded to the results of other investigations. RESULTS HH was intraoperatively diagnosed in 11/41 patients (26.8%). In 10/11 patients, the preoperative HRM showed an esophagogastric junction suggestive of HH. When compared to intraoperative evaluation, the sensitivity of the HRM was 90.9% and the specificity 63.3%, with a positive predictive value of 47.6% and a negative predictive value of 95.0%. HRM showed a higher sensitivity and specificity compared to barium swallow and UGIE. CONCLUSIONS HRM has a high accuracy of HH detection in morbidly obese patients assuming an intraoperative diagnosis as reference standard. It could therefore be a very useful tool in the preoperative work-up of obese patients undergoing bariatric surgery.
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Affiliation(s)
- Antonella Santonicola
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Via S. Leonardo 1, 84131, Salerno, Italy
| | - Luigi Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - Antonio Vitiello
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - Salvatore Tolone
- Surgery Unit, Department of Surgery, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Nigel John Trudgill
- Department of Gastroenterology, Sandwell General Hospital, West Bromwich, Birmingham, UK
| | - Carolina Ciacci
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Via S. Leonardo 1, 84131, Salerno, Italy
| | - Paola Iovino
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Via S. Leonardo 1, 84131, Salerno, Italy.
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Mazzini GS, Madalosso CA, Campos GM, Khoraki J, Barão FR, Navarini D, Gurski RR. Factors Associated to Abnormal Distal Esophageal Exposure to Acid and Esophagitis in Individuals Seeking Bariatric Surgery. Surg Obes Relat Dis 2019; 15:710-716. [DOI: 10.1016/j.soard.2019.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/28/2018] [Accepted: 01/31/2019] [Indexed: 12/12/2022]
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Felsenreich DM, Langer FB, Prager G. Comments on the Letter to the Editor "The Gastric Migration Crisis in Obesity Surgery". Obes Surg 2019; 29:2305-2306. [PMID: 30982166 DOI: 10.1007/s11695-019-03874-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Daniel M Felsenreich
- Department of Surgery, Division of General Surgery, Vienna Medical University, Währinger Guertel 18-20, 1090, Vienna, Austria
| | - Felix B Langer
- Department of Surgery, Division of General Surgery, Vienna Medical University, Währinger Guertel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Department of Surgery, Division of General Surgery, Vienna Medical University, Währinger Guertel 18-20, 1090, Vienna, Austria.
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AlEid A, Al Balkhi A, Hummedi A, Alshaya A, Abukhater M, Al Mtawa A, Al Khathlan A, Qutub A, Al Sayari K, Ahmad S, Azhar T, Al Otaibi N, Al Ghamdi A, Al Lehibi A. The utility of esophagogastroduodenoscopy and Helicobacter pylori screening in the preoperative assessment of patients undergoing bariatric surgery: A cross-sectional, single-center study in Saudi Arabia. Saudi J Gastroenterol 2019; 26:32-38. [PMID: 31898643 PMCID: PMC7045771 DOI: 10.4103/sjg.sjg_165_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIM Esophagogastroduodenoscopy (EGD) and Helicobacter pylori screening are routine parts of the preoperative assessment of patients undergoing bariatric surgery at many centers around the world. The reason for this step is to identify abnormalities that may change the surgical approach. In this study, we aim to evaluate the extent to which endoscopic findings and H. pylori testing affect the plan of care in bariatric patients. PATIENTS AND METHODS We retrospectively reviewed the investigational processes of 356 patients planned for bariatric surgery (2014-2016) at our center. Patients were categorized into two main groups (4 subgroups) from endoscopic findings. One group included patients with normal EGD and patients who had abnormal findings that did not change the surgical approach, whereas the other included patients who had findings that changed or canceled the surgical plan. A logistic regression analysis was used to evaluate how strongly can factors such as patient demographics, BMI, comorbidities, symptomatology, and H. pylori status predict the risk of having plan-changing endoscopic abnormalities. RESULTS The ages ranged between 15 and 66 years with a mean ± SD of 37 ± 11 years, and 56% were females. The majority of patients (75%; 95% CI: 73 - 82%) had either no findings (41%) or had abnormalities that did not change the surgical approach (34%). Only 25% (95% CI: 21-29%) were found to have pathologies that altered the surgical approach, and 0.6% of them had findings that were considered contraindications for surgery. In spite the relatively high prevalence of H. pylori in our cohort (41%; 95% CI 36-46%), the proportion of patients who had plan-changing abnormalities did not differ markedly from other studies. Gastroesophageal reflux disease (GERD) and obstructive sleep apnea symptoms were the only significant predictors of EGD findings (P = 0.009). CONCLUSIONS GERD and sleep apnea symptoms can be strong predictors of EGD abnormalities. However, this evidence is still not enough to safely recommend changing the current practice. Therefore, until a sensitive clinical prediction score is derived and validated according to the symptoms, we suggest that EGD should continue as the standard of care in all patients undergoing bariatric surgery.
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Affiliation(s)
- Ahmad AlEid
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia,Address for correspondence: Dr. Ahmad AlEid, Department of Gastroenterology and Hepatology, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia. E-mail:
| | - Areej Al Balkhi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Hummedi
- Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Anfal Alshaya
- Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Muhammad Abukhater
- Department of Surgical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Mtawa
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Khathlan
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Adel Qutub
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Al Sayari
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shameem Ahmad
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tauseef Azhar
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nawaf Al Otaibi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed Al Ghamdi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abed Al Lehibi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
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Kassir R, Kassir R, Deparseval B, Bekkar S, Serayssol C, Favre O, Garnier PP. Routine surveillance endoscopy before and after sleeve gastrectomy? World J Gastrointest Endosc 2019; 11:1-4. [PMID: 30705727 PMCID: PMC6354110 DOI: 10.4253/wjge.v11.i1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/22/2018] [Accepted: 12/30/2018] [Indexed: 02/06/2023] Open
Abstract
There is no consensus when it comes to the necessity of an oeso-gastroduodenal fibroscopy (OGDF) before and after bariatric surgery. Many reports expressed the preoccupations about a gastroesophagal reflux disease (an acute risk of Barrett’s esophagus) and its consequences after a sleeve gastrectomy (SG) and the risk of leaving a premalignant lesion in an excluded stomach after a Roux-en-Y gastric bypass. The International Federation for the Surgery of Obesity and Metabolic Disorders recommends a surveillance endoscopy, routinely after a SG. After review of the literature, we set out the arguments in favor of performing a systematic preoperative and post-operative OGDF.
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Affiliation(s)
- Radwan Kassir
- Department of Bariatric Surgery, CHU Félix Guyon, La Réunion, Saint Denis 97400, France
| | - Rani Kassir
- Department of Bariatric Surgery, CHU Félix Guyon, La Réunion, Saint Denis 97400, France
| | - Bénédicte Deparseval
- Department of Bariatric Surgery, CHU Félix Guyon, La Réunion, Saint Denis 97400, France
| | - Sarah Bekkar
- Department of Bariatric Surgery, CHU Félix Guyon, La Réunion, Saint Denis 97400, France
| | - Chloé Serayssol
- Department of Bariatric Surgery, CHU Félix Guyon, La Réunion, Saint Denis 97400, France
| | - Olivier Favre
- Department of Gastroenterology, CHU Félix Guyon, La Réunion, Saint Denis 97400, France
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Is Routine Preoperative Esophagogastroduodenoscopy Screening Necessary Prior to Laparoscopic Sleeve Gastrectomy? Review of 1555 Cases and Comparison with Current Literature. Obes Surg 2018; 28:52-60. [PMID: 28685362 DOI: 10.1007/s11695-017-2813-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Controversy exists as to whether routine preoperative esophagogastroduodenoscopy (p-OGD) in bariatric surgery should be routinely undertaken or undertaken selectively based on patients' symptoms. As very few studies have focused on the role of p-OGD prior to the increasingly common laparoscopic sleeve gastrectomy (LSG), we assessed the role/impact of p-OGD in LSG patients. METHODS Retrospective review of records of all LSG patients operated upon at Hamad General Hospital, Qatar (2011-2014, n = 1555). All patients were screened by p-OGD. Patient characteristics were analyzed, and p-OGD findings were categorized into four groups employing Sharaf et al.'s classification (Obes Surg 14:1367-1372, 23). We assessed the impact of p-OGD findings on any change in surgical management or lack thereof. RESULTS p-OGD findings indicated that 89.5% of our patients had normal or mild findings and were asymptomatic (groups 0 and 1, not necessitating any change in surgical management), and no patients had gastric cancer or varices (group 3). A total of 10.5% of our sample were categorized as group 2 patients who, according to Sharaf et al. (Obes Surg 14:1367-1372, 23), might have their surgical approach changed. All patients diagnosed preoperatively with hiatal hernia (HH) had LSG with crural repair and their symptoms resolved postoperatively. CONCLUSION Due to effectiveness and best utilization of resources, routine p-OGD screening in patients scheduled for LSG may require further justification for asymptomatic patients especially in regions with low upper GI cancers. p-OGD findings had low impact on the management of asymptomatic patients. Crural repair plus LSG was effective for hiatal hernia.
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Bencsath KP. Comment on: is preoperative gastroscopy necessary prior to sleeve gastrectomy and Roux-en-Y gastric bypass? Surg Obes Relat Dis 2018; 14:762-763. [PMID: 29571636 DOI: 10.1016/j.soard.2018.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 02/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Kalman P Bencsath
- Department of General Surgery, Cleveland Clinic, Mayfield Heights, Ohio
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Barakat EAME, Abbas NF, El-Kholi NY. Primary bile reflux gastritis versus Helicobacter pylori gastritis: a comparative study. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2018. [DOI: 10.4103/ejim.ejim_42_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Csendes A. "Upper Gastrointestinal Endoscopy Prior to Bariatric Surgery. Mandatory or Expendable? An Analysis of 801 Cases". Obes Surg 2018; 28:1148. [PMID: 29417485 DOI: 10.1007/s11695-018-3133-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Weis JJ, Goldblatt M, Pryor A, Dunkin BJ, Brunt LM, Jones DB, Scott DJ. SAGES's advanced GI/MIS fellowship curriculum pilot project. Surg Endosc 2018; 32:2613-2619. [PMID: 29344791 DOI: 10.1007/s00464-018-6020-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/03/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The American health care system faces deficits in quality and quantity of surgeons. SAGES is a major stakeholder in surgical fellowship training and is responsible for defining the curriculum for the Advanced GI/MIS fellowship. SAGES leadership is actively adapting this curriculum. METHODS The process of reform began in 2014 through a series of iterative meetings and discussions. A working group within the Resident and Fellow Training Committee reviewed case log data from 2012 to 2015. These data were used to propose new criteria designed to provide adequate exposure to core content. The working group also proposed using video assessment of an MIS case to provide objective assessment of competency. RESULTS Case log data were available for 326 fellows with a total of 85,154 cases logged (median 227 per fellow). The working group proposed new criteria starting with minimum case volumes for five defined categories including foregut (20), bariatrics (25), inguinal hernia (10), ventral hernia (10), and solid organ/colon/thoracic (10). Fellows are expected to perform an additional 75 complex MIS cases of any category for a total of 150 required cases overall. The proposal also included a minimum volume of flexible endoscopy (50) and submission of an MIS foregut case for video assessment. The new criteria more clearly defined which surgeon roles count for major credit within individual categories. Fourteen fellowships volunteered to pilot these new criteria for the 2017-2018 academic year. CONCLUSIONS The new SAGES Advanced GI/MIS fellowship has been crafted to better define the core content that should be contained in these fellowships, while still allowing sufficient heterogeneity so that individual learners can tailor their training to specific areas of interest. The criteria also introduce innovative, evidence-based methods for assessing competency. Pending the results of the pilot program, SAGES will consider broad implementation of the new fellowship criteria.
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Affiliation(s)
- Joshua J Weis
- University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX, 75390-9092, USA
| | | | - Aurora Pryor
- Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | | | - L Michael Brunt
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Daniel J Scott
- University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX, 75390-9092, USA.
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Rare Entities of Histopathological Findings in 755 Sleeve Gastrectomy Cases: a Synopsis of Preoperative Endoscopy Findings and Histological Evaluation of the Specimen. Obes Surg 2017; 28:1289-1295. [DOI: 10.1007/s11695-017-3014-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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The utility of routine esophagogastroduodenoscopy before laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2017; 13:1717-1722. [PMID: 28754464 DOI: 10.1016/j.soard.2017.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/05/2017] [Accepted: 06/27/2017] [Indexed: 01/17/2023]
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Abstract
A substantial decrease in Helicobacter pylori-associated peptic ulcer disease has been observed during the last decades. Drug-related ulcers as well as idiopathic ulcers are becoming predominant and are more refractory to treatment; however, H. pylori infection still plays an important role in ulcer bleeding and recurrence after therapy. The effect of H. pylori eradication upon functional dyspepsia symptoms has been reviewed in this article and generally confirms the results of previous meta-analyses. Additional evidence suggests a lack of impact upon the quality of life, in spite of improvement in symptoms. The association of H. pylori with gastroesophageal reflux disease and Barrett's esophagus remains controversial with a majority of published studies showing a negative association. Furthermore, a strong inverse relationship between the presence of H. pylori and the esophageal eosinophilia was also reported. Several studies and a review addressed the role of H. pylori in autoimmune gastritis and pernicious anemia. The association of the above still remains controversial. Finally, the necessity of routine endoscopy and H. pylori eradication before bariatric surgery is discussed. Several studies suggest the rationale of preoperative upper endoscopy and H. pylori eradication prior to surgery. However, the prevalence of H. pylori infection prior to surgery in these studies generally reflects the overall prevalence of the infection in the particular geographic area. In addition, results on the role of H. pylori in developing postoperative complications remain controversial.
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Affiliation(s)
- Olga Sjomina
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia.,Riga East University Hospital, Riga, Latvia
| | - Frederic Heluwaert
- Hepato-gastroenterology department, Annecy Genevois Hospital, Pringy, France
| | - Driffa Moussata
- Gastroenterology department, Tours University Hospital, Tours, France
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia.,Riga East University Hospital, Riga, Latvia.,Digestive Diseases Centre GASTRO, Riga, Latvia
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