[Should fiber gastroscopy be standard in preoperative examinations for cardiac surgery?]

We introduced a gastrofibroscopy into a standard preoperative protocol for all patients indicated to the cardiac surgery.

Validation of our protocol.

957 consecutive patients operated on from May 1995 to January 2002 were divided to group A--gastrofibroscopy only for patients with positive history or clinical signs of peptic ulcer (151 pts.) and group B--patients with gastrofibroscopy as a standard procedure (806 pts).

Significant difference in incidence of peptic ulcer complications between groups (A--5.9% versus B--1.1%, p < 0.05). Related mortality was 1.3% in-group A versus 0% in-group B. Positive history of peptic ulcer had only two patients (11% of 18) with postoperative complication. In-group B we found high incidence of peptic defects (B--35% versus A--9%, p < 0.01) requiring treatment by gastroenterologist. Majority (230 of 281-82%) of pts. with preoperative positive defect had negative history of a peptic ulcer.

Current tendency to perform gastrofibroscopic examination only in patients with positive history of peptic ulcer is not able to detect "silent" lesions. Perioperative treatment with H2 blockers fails to prevent the manifestation of peptic ulcer complication. Gastrofibroscopy should be a routine part of the preoperative protocol in cardiac surgery.