Antoine Rioux1, Audrey Viger2, François-Charles Malo3,4. 1. Faculté de médecine et des sciences de la santé de l'Université de Sherbrooke, Sherbrooke, Canada. 2. Service de chirurgie générale, Département de chirurgie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada. 3. Faculté de médecine et des sciences de la santé de l'Université de Sherbrooke, Sherbrooke, Canada. Francois-Charles.Malo@USherbrooke.ca. 4. Service de chirurgie générale, Département de chirurgie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada. Francois-Charles.Malo@USherbrooke.ca.
Abstract
PURPOSE: Esophagogastroduodenoscopy (EGD) is a useful test to diagnose significant pathologies before bariatric surgery. Controversy remains about its role in the preoperative workup of asymptomatic patients. This study aims to describe findings and changes in the management related to EGD. A secondary objective was to review the existing literature on the subject to analyze the role of patients' gastrointestinal symptomatology as an indication to undergo a preoperative EGD. MATERIAL AND METHODS: A retrospective chart review of patients operated at the Centre hospitalier universitaire de Sherbrooke (CHUS) since the opening of the Clinique médico-chirurgicale du traitement de l'obésité (CMCTO) was conducted, alongside a review of the literature. Pathologic findings on EGD were classified into 4 groups (groups 0 to 3). Results of this study were combined with literature to calculate weighted averages of global sensitivity, specificity, positive/negative predictive values, and likelihood ratios of gastrointestinal symptomatology as a predictor of pathologic endoscopy findings. RESULTS: A total of 737 patients were included in the study. Of those, 236 (35,7%) were considered symptomatic. Significant pathologic findings on EGD (group 2 and 3) were present for 270 patients (36.6%). Changes in medical management occurred in 22.8% of cases and in surgical management in 3.5% of cases. When combining past studies with the present one, the presence of symptoms had a sensitivity of 57.4% and a specificity of 82.4% for findings on EGD. CONCLUSION: Considering that this exam is relatively safe, that it allows uncovering a great number of pathologies altering management, and that symptoms are not a good screening test to decide of its indication, the authors recommend that all bariatric surgery patients undergo an EGD in their preoperative workup.
PURPOSE: Esophagogastroduodenoscopy (EGD) is a useful test to diagnose significant pathologies before bariatric surgery. Controversy remains about its role in the preoperative workup of asymptomatic patients. This study aims to describe findings and changes in the management related to EGD. A secondary objective was to review the existing literature on the subject to analyze the role of patients' gastrointestinal symptomatology as an indication to undergo a preoperative EGD. MATERIAL AND METHODS: A retrospective chart review of patients operated at the Centre hospitalier universitaire de Sherbrooke (CHUS) since the opening of the Clinique médico-chirurgicale du traitement de l'obésité (CMCTO) was conducted, alongside a review of the literature. Pathologic findings on EGD were classified into 4 groups (groups 0 to 3). Results of this study were combined with literature to calculate weighted averages of global sensitivity, specificity, positive/negative predictive values, and likelihood ratios of gastrointestinal symptomatology as a predictor of pathologic endoscopy findings. RESULTS: A total of 737 patients were included in the study. Of those, 236 (35,7%) were considered symptomatic. Significant pathologic findings on EGD (group 2 and 3) were present for 270 patients (36.6%). Changes in medical management occurred in 22.8% of cases and in surgical management in 3.5% of cases. When combining past studies with the present one, the presence of symptoms had a sensitivity of 57.4% and a specificity of 82.4% for findings on EGD. CONCLUSION: Considering that this exam is relatively safe, that it allows uncovering a great number of pathologies altering management, and that symptoms are not a good screening test to decide of its indication, the authors recommend that all bariatric surgery patients undergo an EGD in their preoperative workup.
Authors: Daniel Moritz Felsenreich; Ronald Kefurt; Martin Schermann; Philipp Beckerhinn; Ivan Kristo; Michael Krebs; Gerhard Prager; Felix B Langer Journal: Obes Surg Date: 2017-12 Impact factor: 4.129
Authors: S Sauerland; L Angrisani; M Belachew; J M Chevallier; F Favretti; N Finer; A Fingerhut; M Garcia Caballero; J A Guisado Macias; R Mittermair; M Morino; S Msika; F Rubino; R Tacchino; R Weiner; E A M Neugebauer Journal: Surg Endosc Date: 2004-12-02 Impact factor: 4.584