Is Routine Preoperative Esophagogastroduodenoscopy Prior to Bariatric Surgery Mandatory? Systematic Review and Meta-analysis of 10,685 Patients

Abstract

Background This systematic review and meta-analysis searched, retrieved and synthesized the evidence as to whether preoperative esophagogastroduodenoscopy (p-EGD) should be routine before bariatric surgery (BS). Methods Databases searched for retrospective, prospective, and randomized (RCT) or quasi-RCT studies (01 January 2000–30 April 2019) of outcomes of routine p-EGD before BS. STROBE checklist assessed the quality of the studies. P-EGD findings were categorized: Group 0 (no abnormal findings); Group 1 (abnormal findings that do not necessitate changing the surgical approach or postponing surgery); Group 2 (abnormal findings that change the surgical approach or postpone surgery); and Group 3 (findings that signify absolute contraindications to surgery). We assessed data heterogeneity and publication bias. Random effect model was used. Results Twenty-five eligible studies were included (10,685 patients). Studies were heterogeneous, and there was publication bias. Group 0 comprised 5424 patients (56%, 95% CI: 45–67%); Group 1, 2064 patients (26%, 95% CI: 23–50%); Group 2, 1351 patients (16%, 95% CI: 11–21%); and Group 3 included 31 patients (0.4%, 95% CI: 0–1%). Conclusion For 82% of patients, routine p-EGD did not change surgical plan/ postpone surgery. For 16% of patients, p-EGD findings necessitated changing the surgical approach/ postponing surgery, but the proportion of postponements due to medical treatment of H Pylori as opposed to “necessary” substantial change in surgical approach is unclear. For 0.4% patients, p-EGD findings signified absolute contraindication to surgery. These findings invite a revisit to whether p-EGD should be routine before BS, and whether it is judicious to expose many obese patients to an invasive procedure that has potential risk and insufficient evidence of effectiveness. Further justification is required.

Newly diagnosed Crohn’s disease, and hepatocellular and renal cell carcinoma in a bariatric surgery patient—dealing with the complexity of obesity-associated diseases: a case report and review of the literature

“…The importance and necessity of routine EGD prior BS is still a matter of debate. A systematic meta-analysis of 10,685 patients showed that in 82% EGD did not change the surgical plan and therefore questions its justification [ 8 ]. American guidelines recommend preoperative EGD only for symptomatic patients, while in Europe it is recommended for all bariatric patients [ 9 ].…”

Cáncer gástrico y cirugía bariátrica: a propósito de un caso

“…La EDA preoperatoria es fundamental como screening de lesiones premalignas, pero su realización es controversial 14 . Algunos autores han encontrado anormalidades en hasta 16% de los pacientes, cambiando la conducta quirúrgica final 15 . Sin embargo, otros plantean que solamente se identifican anormalidades inespecíficas, clínicamente irrelevantes y que podrían conllevar a tratamientos innecesarios 16 .…”

Revisional Surgeries of Laparoscopic Sleeve Gastrectomy

“…However, an increasing amount of evidence shows that HHR is inefficient in preventing the occurrence and development of GERD after LSG. [86][87][88] For patients with obesity, whether receiving LSG and routine preoperative endoscopy 78,89,90 and HHR are necessary requires additional prospective studies. The good news is that LSG with anti-reflux fundoplication emerges as a new valid option for patients with GERD.…”