Benefit of preoperative flexible endoscopy for patients undergoing weight-reduction surgery in Saudi Arabia

Little information is available to demonstrate the importance of flexible endoscopic examination of the upper gastrointestinal tract in obese patients prior to the weight-reduction surgery. In spite of the controversies, there are more evidences to support the value of preoperative endoscopy. In this study, we aimed to evaluate the benefit of preoperative endoscopy in morbidly obese patients who have planned to undergo bariatric surgery.

The medical records of morbidly obese patients who were admitted to our hospital from November 2004 to January 2007 and underwent flexible esophagogastroduodenoscopy (EGD) prior to the weight-reduction surgery were reviewed. The endoscopic findings and demographic data were recorded and analyzed.

Sixty-five patients underwent EGD preoperatively. The mean age was 34.6 years (range: 18-52 years), their mean BMI was 57 (range: 35-92) with a maximum weight of 280 kg. Majority were females (64%). Endoscopic findings included gastritis in 44 patients (67.7%), hiatus hernia in 8 (12%), gastric erosions in 7 (10.7%), reflux esophagitis in 4 (6%) and normal EGD findings in 15 patients (23%). There was no significant increase in reflux esophagitis in this group of patients. Sixty percent of the patients had comorbid medical conditions with diabetes mellitus being the most common.

These data suggest that it might be necessary to perform preoperative EGD in patients undergoing bariatric surgery, although it possibly will not alter the surgical intervention. Prospectively conducted studies with larger number of patients are required to further explore the need of EGD in this subset of patients.