Is preoperative gastroscopy necessary before sleeve gastrectomy and Roux-en-Y gastric bypass?

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Saarinen , T , Kettunen , U , Pietiläinen , K H & Juuti , A 2018 , ' Is preoperative gastroscopy necessary before sleeve gastrectomy and Roux-en-Y gastric bypass? ' , Surgery for Obesity and Related Diseases , vol. 14 , no. 6 , pp. 757-762 .

Title: Is preoperative gastroscopy necessary before sleeve gastrectomy and Roux-en-Y gastric bypass?
Author: Saarinen, Tuure; Kettunen, Ulla; Pietiläinen, Kirsi H.; Juuti, Anne
Contributor organization: Clinicum
II kirurgian klinikka
Department of Surgery
Diabetes and Obesity Research Program
Research Programs Unit
University of Helsinki
HUS Abdominal Center
Date: 2018-06
Language: eng
Number of pages: 6
Belongs to series: Surgery for Obesity and Related Diseases
ISSN: 1550-7289
Abstract: Background: Consensus on the necessity of esophagogastroduodenoscopy (EGD) before bariatric surgery is lacking. Recommendations and practices vary by country and unit. Several reports have expressed concerns on gastroesophageal reflux disease (GERD) and its consequences after sleeve gastrectomy (SG) and the risk of leaving a premalignant lesion in the excluded stomach after Roux en -Y gastric bypass (RYGB). Objectives: We explored the number and types of clinically significant findings in preoperative EGDs and how they associate with preexisting GERD-symptoms (SG) and premalignant lesions (RYGB). We also studied how many reoperations were performed due to postoperative GERD in SG-patients. Setting: University hospital. Methods: We investigated preoperative EGD-findings and gastrointestinal symptoms before bariatric surgery in all patients with a primary bariatric operation in our unit between December 2007 and May 2016. Results: We performed 1474 operations: 1047 (71.0%) RYGB, 407 (27.6%) SG, and 20 (1.4%) others. One thousand two hundred seventy-five (86.5%) preoperative EGD reports were analyzed: 647 (50.7%) EGDs were completely normal. Altogether, 294 patients (23.0% of total) had a clinically significant finding that was relevant for SG (hiatal hernia, esophagitis, Barrett's esophagus, esophageal dysplasia), 144 (49.0%) of whom reported gastrointestinal symptoms. Twenty patients (1.6%) had a significant finding relevant for RYGB (peptic ulcer, atrophic gastritis, gastrointestinal stromal tumor), and 6 (30%) reported gastrointestinal symptoms. Thirteen (3.2%) SGs were converted into RYGB due to GERD. Conclusions: Preoperative EGD is indicated before SG but not before RYGB for asymptomatic patients without a risk for gastric pathology. (C) American Society for Metabolic and Bariatric Surgery. All rights reserved.
Subject: 3126 Surgery, anesthesiology, intensive care, radiology
Bariatric Surgery
Sleeve Gastrectomy
Preoperative gastroscopy
Roux-en-Y Gastric Bypass
Peer reviewed: Yes
Rights: cc_by_nc_nd
Usage restriction: openAccess
Self-archived version: acceptedVersion

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