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

Saarinen, Tuure; Kettunen, Ulla; Pietiläinen, Kirsi H.; Juuti, Anne

doi:10.1016/j.soard.2018.01.021

Cited by 33 publications

(16 citation statements)

References 22 publications

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“…Schatzki ring or stricture was noted in 0.5% to 3.0% of patients in the literature. 8,13,24 Strictures may have more serious implications and should be evaluated prior to surgery to rule out underlying malignancy. It can also be seen as a marker of severity of reflux prompting avoidance of SG.…”

Section: Discussionmentioning

confidence: 99%

“…Barrett's esophagus or intestinal metaplasia was noted in 3.1% of our patients with a prevalence of 0.2% to 3.1% in the literature. 8,10,14,24 Although this diagnosis is not prominent, it may lead to a delay in surgery, medical treatment, repeat EGD procedures, or change in procedure choice. At the most recent international consensus conference on sleeve gastrectomy, 94.5% of experts agreed that Barrett's esophagus is a major contraindication to the performance of SG.…”

Section: Discussionmentioning

confidence: 99%

“…10 A few other studies have reported cases of early gastric cancers or gastrointestinal stromal tumors diagnosed on preoperative bariatric surgery EGD assessment. 24,26 There are several case studies detailing the diagnosis of gastric pouch or remnant cancers after LRYGB. [27][28][29] The majority of these cancers seem to occur in the excluded stomach leading to delays in diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of Upper Gastrointestinal Pathology in Patients with Obesity on Preoperative Endoscopy

Makiewicz

Berbiglia²,

Douglas

et al. 2020

JSLS

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Background and Objectives: The preoperative work up for bariatric surgery is variable and not all centers perform a preoperative upper gastrointestinal endoscopy. A study was undertaken to determine the frequency of clinically significant gross endoscopic and pathological diagnoses in a large sample of patients with obesity undergoing work-up for bariatric surgery. Methods: Routine endoscopy was performed on all preoperative bariatric patients. A retrospective chart review of 1000 consecutive patients was performed. Patients were divided into three groups: Group A (no endoscopic findings), Group B (clinically insignificant findings), Group C (clinically significant findings). Results: Patients had a mean body mass index (BMI) of 49 kg/m2 and 79% were female. In this sample one finding was found on preoperative EGD in 95.2% of patients, 33.9% had at least two diagnoses, and 29.9% had three or more diagnoses. Group A (no findings) consisted of 4.8% of patient, 52.5% in Group B (clinically insignificant findings), and 42.7% were in Group C (clinically significant findings). Clinically significant findings included hiatal hernia 23.5%, esophagitis 9.5%, H. pylori 7.1%, gastric erosions 5.7%, duodenitis 3.7%, Barrett's esophagus 3.1%, and Schatzki ring 1.2%. There was no significant correlation between preoperative BMI and any endoscopic findings (all p-value 0.05). Patients in Group C were statistically older than Groups A and B. Conclusion: Upper gastrointestinal pathology is highly common in patients with obesity. There is a significant rate of clinically significant endoscopy findings and all bariatric surgery patients should undergo preoperative endoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prevalence of Upper Gastrointestinal Pathology in Patients with Obesity on Preoperative Endoscopy

Makiewicz

Berbiglia²,

Douglas

et al. 2020

JSLS

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“…The ASMBS guidelines advocates the use of UGIE preoperatively on a selective basis based on the presence of symptoms [16]. This is in contrast to the observation by another study that found significant findings relevant for SG (hiatus hernia, esophagitis, Barrett's esophagus, esophageal dysplasia) in 23% patients, of whom only half were symptomatic and the authors concluded that preoperative UGIE was indicated before SG for all patients irrespective of symptoms [17]. Once again, significant variation was observed in this survey with only 65% surgeons advocating routine UGIE before SG.…”

Section: Discussionmentioning

confidence: 83%

Perioperative Practices Concerning Sleeve Gastrectomy – a Survey of 863 Surgeons with a Cumulative Experience of 520,230 Procedures

et al. 2019

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Background Sleeve Gastrectomy (SG) is the most commonly performed bariatric procedure worldwide. There is currently no scientific study aimed at understanding variations in practices concerning this procedure. The aim of this study was to study the global variations in perioperative practices concerning SG. Methods A 37-item questionnaire-based survey was conducted to capture the perioperative practices of the global community of bariatric surgeons. Data were analysed using descriptive statistics. Results Response of 863 bariatric surgeons from 67 countries with a cumulative experience of 520,230 SGs were recorded. A total of 689 (80%) and 764 (89%) surgeons listed 13 absolute and relative contraindications, respectively. 65% (n = 559) surgeons perform routine preoperative endoscopy and 97% (n=835) routinely use intraoperative orogastric tube for sizing the resection. A wide variation is observed in the diameter of the tube used. 73% (n=627) surgeons start dividing the stomach at a distance of 3-5 cm from the pylorus, and 54% (n=467) routinely use staple line reinforcement. Majority (65%, n=565) of surgeons perform routine intraoperative leak test at the end of the procedure, while 25% (n=218) surgeons perform a routine contrast study in the early postoperative period. Lifelong 2 multivitamin/mineral, iron, vitamin D, calcium, and vitamin B12 supplementation is advocated by 66%, 29%, 40%, 38% and 44% surgeons, respectively. Conclusion There is a considerable variation in the perioperative practices concerning SG. Data can help in identifying areas for future consensus building and more focussed studies.

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“…Saarinen et al[7] concluded that a pre-operative OGDF is recommended before a SG, but it is not mandatory before a RYGB for asymptomatic patients without any risk factor for gastric pathology (family history of gastric cancer, H. pylori infection, nonsteroidal antiinflammatory drugs usage, tabagism, age > to 50 years, kidneys, heart or lungs chronic diseases). The American Society for Gastrointestinal Endoscopy and the American Society for Metabolic and Bariatric Surgery defined some guidelines rooted from evidence-based medicine[8].…”

Section: Pre-operative Oeso-gastroduodenal Fibroscopymentioning

confidence: 99%

Routine surveillance endoscopy before and after sleeve gastrectomy?

Kassir

Deparseval

Bekkar

et al. 2019

WJGE

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There is no consensus when it comes to the necessity of an oeso-gastroduodenal fibroscopy (OGDF) before and after bariatric surgery. Many reports expressed the preoccupations about a gastroesophagal reflux disease (an acute risk of Barrett’s esophagus) and its consequences after a sleeve gastrectomy (SG) and the risk of leaving a premalignant lesion in an excluded stomach after a Roux-en-Y gastric bypass. The International Federation for the Surgery of Obesity and Metabolic Disorders recommends a surveillance endoscopy, routinely after a SG. After review of the literature, we set out the arguments in favor of performing a systematic preoperative and post-operative OGDF.

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

Abstract: Preoperative EGD is indicated before SG but not before RYGB for asymptomatic patients without a risk for gastric pathology.

Cited by 33 publications

References 22 publications

Prevalence of Upper Gastrointestinal Pathology in Patients with Obesity on Preoperative Endoscopy

Prevalence of Upper Gastrointestinal Pathology in Patients with Obesity on Preoperative Endoscopy

Perioperative Practices Concerning Sleeve Gastrectomy – a Survey of 863 Surgeons with a Cumulative Experience of 520,230 Procedures

Routine surveillance endoscopy before and after sleeve gastrectomy?

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