Preoperative Endoscopic and Radiologic Evaluation of Bariatric Patients: What Do They Add?

Area of Science:

• Gastroenterology
• Bariatric Surgery
• Diagnostic Imaging

Background:

• Preoperative esophagogastroduodenoscopy (EGD) and barium swallow (BS) are standard but debated evaluations for bariatric surgery candidates.
• High prevalence of gastrointestinal abnormalities exists in this patient population.

Purpose of the Study:

• To evaluate the diagnostic yield and impact of preoperative EGD and BS in bariatric surgery patients.
• To determine the utility of these imaging modalities in surgical decision-making.

Main Methods:

• Retrospective review of a prospectively maintained database of primary bariatric surgery patients (March 2013 - August 2016).
• Analysis of data from 209 patients who underwent both EGD and BS.

Main Results:

• Preoperative EGD revealed abnormalities in 87.5% of patients, including esophagitis (54.5%) and gastritis (51%).
• Hiatal hernia (HH) was detected in 52.2% by EGD versus 34% by BS. EGD changed surgical plans in 3.34% of cases.
• 80.2% of asymptomatic patients had abnormal EGD findings, and EGD was a better predictor of HH than symptoms.

Conclusions:

• Preoperative EGD is crucial for identifying abnormalities in most bariatric surgery patients, irrespective of symptoms.
• EGD provides tissue sampling for definitive diagnosis and influences surgical approach, making it superior to BS.
• Routine use of barium swallow (BS) in preoperative bariatric surgery evaluation is not recommended due to its low diagnostic accuracy.