Preoperative endoscopy in revisional bariatric surgery: who should hold the scope?

Preoperative esophagogastroduodenoscopy (EGD) is a key component of revisional bariatric surgery workup. However, the completeness and surgical relevance of reports may vary depending on whether the examination is performed by a gastroenterologist or a bariatric surgeon. This study aimed to compare the diagnostic completeness and surgical relevance of preoperative EGD reports performed by gastroenterologists with that performed by bariatric surgeons in candidates for revisional bariatric surgery.

This was a retrospective study that reviewed 88 patients who underwent revisional bariatric surgery after sleeve gastrectomy (SG) or gastric bypass (GB) between January 2024 and April 2025 in 2 bariatric centers in France. Patients were divided into 2 groups: group G (endoscopy by gastroenterologists [n = 44]) and group S (endoscopy by bariatric surgeons [n = 44]). Each report was evaluated using a standardized checklist of surgery-relevant items. The primary endpoint was the Completeness Index (CoI; percentage of mandatory items documented). The secondary endpoints included use of objective measurements, classification of sleeve dilation, documentation of bile reflux, and structured reporting.

In the SG subgroup (n = 48), reports by surgeons achieved higher CI scores than those of gastroenterologists (93.5% ± 10.3% vs 69.6% ± 10.6%, respectively; P <.0001). Sleeve dilation classification and bile reflux were consistently documented by surgeons but rarely by gastroenterologists. In the GB subgroup (n = 40), surgeon-performed reports also showed greater completeness than gastroenterologist-performed reports (88.7% ± 11.4% vs 41.2% ± 9.1%, respectively; P <.0001), with more frequent documentation of pouch size, anastomosis diameter, and configuration. Both groups described anatomical landmarks, such as the esophagogastric junction, comparably.

Surgeon-performed EGD provides more complete, surgery-oriented information than gastroenterologist-performed examinations, particularly regarding sleeve morphology, pouch size, and anastomotic configuration. Structured reporting and collaboration are essential for optimizing preoperative evaluation in revisional bariatric surgery.