Endoscopic and histologic findings of the foregut in 426 patients with morbid obesity

Roux-en-Y gastric bypass is the most frequent bariatric operation. In this operation, the distal bypassed stomach is left in situ. We studied pre-operative clinical, endoscopic and histologic findings in a consecutive group of morbidly obese patients prior to bariatric surgery.

A prospective study was conducted from August 1999 until May 2004, which consisted of 426 patients with morbid obesity. There were 94 men and 332 women, with mean age 39.5 years. In all patients prior to surgery, upper endoscopy was performed and biopsy samples were taken distal to squamo-columnar junction (cardiac biopsies), and in 232 of them also in at the antrum.

Pathological findings at the esophagus were seen in 55% of the patients, mainly related to reflux esophagitis. Barrett's esophagus was seen in 5.8%. In the stomach, pathological findings were seen in 32% of the patients. Active peptic ulcer was demonstrated in 2.6% of the cases. At the duodenum, pathologic findings were detected in 13.4% of the patients, showing an ulcer in 2.6%. At the stomach, chronic inactive gastritis and atrophic gastritis with intestinal metaplasia were found in 8.6% and 6.5% respectively. Antral adenoma with low-grade dysplasia was found in 1 patient, and 1 carcinoid tumor. H. pylori was present in 53% of the patients, mainly in the antrum.

In candidates for bariatric surgery, upper endoscopy with biopsy samples and determination of H. pylori should be routinely performed. If present, H. pylori should be eradicated. After surgery, if Barrett's esophagus was present, endoscopic surveillance is recommended.