Arvid Schigt1, Usha Coblijn2, Sjoerd Lagarde1, Sjoerd Kuiken3, Pieter Scholten3, Bart van Wagensveld1. 1. Department of Surgery, Sint Lucas Andreas Ziekenhuis Amsterdam, The Netherlands. 2. Department of Surgery, Sint Lucas Andreas Ziekenhuis Amsterdam, The Netherlands. Electronic address: u.coblijn@slaz.nl. 3. Department of Gastroenterology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Roux-Y Gastric Bypass is a frequently used technique in bariatric surgery. Postoperative anatomy is altered by exclusion of the stomach, which makes this organ inaccessible for future esophagogastroduodenoscopy (EGD). The value of preoperative assessment of the stomach is unclear. Some institutions choose to investigate the future remnant stomach by EGD, others do not. Aim of the present study is to quantify the yield of preoperative EGD in our institution. METHODS: Patients, planned for primary laparoscopic Roux-Y Gastric Bypass (LRYGB) or laparoscopic sleeve gastrectomy from December 2007 until August 2012, were screened by EGD in advance. Results of EGD and patient characteristics were retrospectively analyzed and categorized according to a classification system based on intervention needed. RESULTS: 523 patients (122 male, 401 female, mean age 44.3 years, average BMI 46.6) underwent preoperative EGD. In 257 patients (48.9%) no abnormality was found (group A), 117 patients (17.2%) had abnormalities without treatment consequences (B1), 84 patients (of the 326 tested [comment #1, reviewer #1, 26.8%] were H. Pylori positive (B2), in 75 (14.3%) treatment with proton pump inhibitors was required (B3), 6 (1.1%) required follow up EGD before surgery (C). For1 patient (0.2%) the operation was canceled because preoperative EGD presented with Barrett's esophagus with carcinoma (D). When all abnormalities were taken into account, baselines did show a significant difference for age, gender and reflux symptoms. CONCLUSION: Standard preoperative assessment by EGD in patients who are planned for bariatric surgery is not indicated. The number needed to screen to find clinically significant abnormalities is high.
BACKGROUND: Roux-Y Gastric Bypass is a frequently used technique in bariatric surgery. Postoperative anatomy is altered by exclusion of the stomach, which makes this organ inaccessible for future esophagogastroduodenoscopy (EGD). The value of preoperative assessment of the stomach is unclear. Some institutions choose to investigate the future remnant stomach by EGD, others do not. Aim of the present study is to quantify the yield of preoperative EGD in our institution. METHODS:Patients, planned for primary laparoscopic Roux-Y Gastric Bypass (LRYGB) or laparoscopic sleeve gastrectomy from December 2007 until August 2012, were screened by EGD in advance. Results of EGD and patient characteristics were retrospectively analyzed and categorized according to a classification system based on intervention needed. RESULTS: 523 patients (122 male, 401 female, mean age 44.3 years, average BMI 46.6) underwent preoperative EGD. In 257 patients (48.9%) no abnormality was found (group A), 117 patients (17.2%) had abnormalities without treatment consequences (B1), 84 patients (of the 326 tested [comment #1, reviewer #1, 26.8%] were H. Pylori positive (B2), in 75 (14.3%) treatment with proton pump inhibitors was required (B3), 6 (1.1%) required follow up EGD before surgery (C). For1 patient (0.2%) the operation was canceled because preoperative EGD presented with Barrett's esophagus with carcinoma (D). When all abnormalities were taken into account, baselines did show a significant difference for age, gender and reflux symptoms. CONCLUSION: Standard preoperative assessment by EGD in patients who are planned for bariatric surgery is not indicated. The number needed to screen to find clinically significant abnormalities is high.
Authors: Stefan Wolter; Anna Duprée; Jameel Miro; Cornelia Schroeder; Marie-Isabelle Jansen; Clarissa Schulze-Zur-Wiesch; Stefan Groth; Jakob Izbicki; Oliver Mann; Philipp Busch Journal: Obes Surg Date: 2017-08 Impact factor: 4.129
Authors: Jonathan Z Li; Ryan C Broderick; Estella Y Huang; Joaquin Serra; Samantha Wu; Michael Genz; Bryan J Sandler; Garth R Jacobsen; Santiago Horgan Journal: Surg Endosc Date: 2022-08-10 Impact factor: 3.453
Authors: Manish Parikh; Jennifer Liu; Dorice Vieira; Demetrios Tzimas; Daniel Horwitz; Andrew Antony; John K Saunders; Akuezunkpa Ude-Welcome; Adam Goodman Journal: Obes Surg Date: 2016-12 Impact factor: 4.129
Authors: Jaanus Suumann; Toomas Sillakivi; Živile Riispere; Kari Syrjänen; Pentti Sipponen; Ülle Kirsimägi; Ants Peetsalu Journal: BMC Obes Date: 2018-02-20