Published online May 25, 2016. doi: 10.4253/wjge.v8.i10.409
Peer-review started: August 28, 2015
First decision: September 28, 2015
Revised: March 12, 2016
Accepted: March 17, 2016
Article in press: March 18, 2016
Published online: May 25, 2016
AIM: To study the preoperative and postoperative role of upper esophagogastroduodenoscopy (EGD) in morbidly obese patients.
METHODS: This is a multicenter retrospective study by reviewing the database of patients who underwent bariatric surgery (laparoscopic sleeve gastrectomy, laparoscopic Roux en Y gastric bypass, or laparoscopic minigastric bypass) in the period between 2001 June and 2015 August (Jahra Hospital-Kuwait, Hafr Elbatin Hospital and King Saud Medical City-KSA, and Mansoura University Hospital - Egypt). Patients with age 18-65 years, body mass index (BMI) > 40, or > 35 with comorbidities after failure of many dietetic regimen and acceptable levels of surgical risk were included in the study after having an informed signed consent. We retrospectively reviewed the medical charts of all morbidly obese patients. The patients’ preoperative data included clinical history including upper digestive symptoms and preoperative full workup including EGD. Only patients whose charts revealed weather they were symptomatic or not were studied. We categorized patients accordingly into two groups; with (group A) or without (group B) upper digestive symptoms. The endoscopic findings were categorized into 4 groups based on predetermined criteria. The medical record of patients who developed stricture, leak or bleeding after bariatric surgery was reviewed. Logestic regression analysis was used to identify preoperative predictors that might be associated with abnormal endoscopic findings.
RESULTS: Three thousand, two hundred and nineteen patients in the study period underwent bariatric surgery (75% LSG, 10% LRYDB, and 15% MGB). Mean BMI was 43 ± 13, mean age 37 ± 9 years, 79% were female. Twenty eight percent had presented with upper digestive symptoms (group A). EGD was considered normal in 2414 (75%) patients (9% group A vs 66% group B, P = 0.001). The abnormal endoscopic findings were found high in those patients with upper digestive symptoms. Abnormal findings (one or more) were found in 805 (25%) patients (19% group A vs 6% group B, P = 0.001). Seven patients had critical events during conscious sedation due to severe hypoxemia (< 60%). Rate of stricture in our study was 2.6%. Success rate of endoscopic dilation was 100%. One point nine percent patients with gastric leak were identified with 75% success rate of endoscopic therapy. Three point seven percent patients developed acute upper bleeding. Seventy-eight point two percent patients were treated by conservative therapy and EGD was performed in 21.8% with 100% success and 0% complications.
CONCLUSION: Our results support the performance of EGD only in patients with upper gastrointestinal symptoms. Endoscopy also offers safe effective tool for anastomotic complications after bariatric surgery.
Core tip: It is still a major controversial point to do routine screening endoscopy for obese patients before surgery. Many authors suggest doing upper esophagogastroduodenoscopy (EGD) for all patients before bariatric procedures because of the lack of correlation between patient symptoms and EGD findings. On the contrary, many other investigators advocate selective approach for asymptomatic patients because of the relatively weak clinical relevance of the majority of the lesions discovered on routine EGD along with the cost and invasiveness of the EGD. The upper endoscopy is commonly indicated in the postoperative bariatric patient to evaluate post-bariatric symptoms, to detect and manage complications, as well as evaluation of failure of weight loss. Post-bariatric complications prompting upper endoscopy include bleeding, anastomotic or staple line leaks or fistulae, sleeve stricture in laparoscopic sleeve gastrectomy or stomal stenosis in laparoscopic Roux en Y gastric bypass, or laparoscopic minigastric bypass. We aimed in this retrospective study to answer if it is still necessary to do pre-bariatric screening endoscopy and to evaluate the efficacy and safety of the endoscopic therapy for management of post-bariatric complications.