Preoperative Upper-GI Endoscopy Prior to Bariatric Surgery: Essential or Optional?

Area of Science:

• Gastroenterology
• Bariatric Surgery
• Endoscopy

Background:

• The clinical utility of preoperative upper-gastrointestinal (GI) gastroscopy in bariatric surgery remains a subject of debate.
• Evaluating the prevalence and clinical significance of upper-GI pathologies identified preoperatively is essential for patient management.

Purpose of the Study:

• To determine the incidence of upper-GI pathologies detected by endoscopy before bariatric surgery.
• To assess the clinical impact of these findings on patient management and surgical strategy.

Main Methods:

• A retrospective analysis of a prospectively established database of 636 obese patients undergoing bariatric surgery between January 2011 and December 2017.
• Review of perioperative endoscopic findings and their influence on patient management.

Main Results:

• Preoperative endoscopy identified peptic ulcers (3.5%), Helicobacter pylori gastritis (22.4%), polyps (6.8%), and reflux esophagitis (21.9%).
• Barrett's esophagus was diagnosed histologically in 15.0% of patients.
• Operative strategy changes were required in 1.6% of cases due to detected pathologies.

Conclusions:

• Preoperative upper-GI endoscopy detects a spectrum of abnormalities in obese patients undergoing bariatric surgery.
• These findings significantly influence clinical decision-making regarding surgical procedure selection and follow-up care.
• Routine preoperative upper-GI endoscopy is recommended for all patients prior to bariatric procedures.