Routine Preoperative Oesophagogastroduodenoscopy Before Roux-En-Y Gastric Bypass: A Retrospective Cohort Analysis...

The role of routine preoperative oesophagogastroduodenoscopy (POOGD) with routine biopsies prior to Roux-en-Y gastric bypass (RYGB) remains controversial. Whether POOGD should be routinely offered or reserved for symptomatic and/or at-risk patients is heavily debated. This study aimed to determine the proportion of patients undergoing RYGB in whom POOGD altered surgical management.

A retrospective review of medical records from 2016 to 2024 was performed using data from Surgery Brisbane, Queensland, Australia. Demographic data, clinical characteristics, POOGD findings, and operative outcomes were collected. POOGD findings were categorised as benign (e.g., oesophagitis, gastritis, duodenitis, peptic ulcer disease [PUD], hiatus hernia [HH]) or premalignant (e.g., intestinal metaplasia [IM], Barrett's oesophagus [BO] and Helicobacter pylori infection [HP]).

A total of 423 patients were planned to undergo RYGB; 346 (81.8%) were female. The majority of patients had three or more comorbidities (81.8%) and a preoperative BMI of $\ge$  35 kg/m² (88.2%). POOGD identified abnormalities in 338 patients (80.0%), including benign findings in 235 (55.6%) and premalignant findings in 103 (24.3%). The most common benign findings were oesophagitis (184, 43.5%) and gastritis (175, 41.4%). IM was identified in 54 patients (12.8%), including three (0.7%) with corpus involvement. Amongst patients with premalignant findings, 32 (31.1%) were asymptomatic. POOGD findings altered surgical management in 18 patients (4.2%): 14 (3.3%) underwent RYGB plus resection of the remnant stomach (RRS), two (0.5%) experienced a delay due to untreated PUD, and two (0.5%) were offered an alternative bariatric procedure. Four hundred and five patients (95.7%) proceeded with RYGB as planned.

RYGB alters gastric anatomy, rendering the remnant stomach inaccessible postoperatively. Preoperative detection of premalignant lesions may be uncommon but clinically valuable, particularly given that such findings can be asymptomatic and may represent precursors to gastric adenocarcinoma. Considering its safety, diagnostic value, and potential to alter surgical management, the findings of this study support the routine use of POOGD with routine biopsies prior to RYGB.