Routine Screening Endoscopy before Bariatric Surgery: Is It Necessary?

Gómez, Victoria; Bhalla, Rajat; Heckman, Michael G.; Florit, Paul T. Kröner; Diehl, Nancy N.; Rawal, Bhupendra; Lynch, Scott A.; Loeb, David S.

doi:10.1089/bari.2014.0024

Cited by 43 publications

(20 citation statements)

References 22 publications

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“…In general, prospective studies that implemented pre-operative endoscopy demonstrated changes the surgical treatment in about 2-3 % of cases. Additionally, the information obtained did alter the medical management for GERD in approximately 50 % [7,8]. In our case, it is possible that a pre-operative endoscopy would have revealed a specific pathology such as a stricture that could have led to a subsequent injury, but the lack of symptoms suggests that this is just speculative.…”

Section: Discussionmentioning

confidence: 77%

Benefits of Intraoperative Endoscopy: Case Report and Review of 300 Sleeves Gastrectomies

Ameer¹

2015

Obesity

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Background:The laparoscopic sleeve gastrectomy (LSG) is the fastest rising bariatric procedure being performed in the United States. Some surgeons advocate for an intra-operative endoscopy for their leak test, while others utilize air via a form of an oral gastric tube. We present a case demonstrating the benefits of endoscopy intra-operatively as well as discuss our experience of 200 consecutive sleeve gastrectomies. Case presentation:The case is a 37 years old female undergoing LSG for treatment for morbid obesity. As is our practice, we routinely perform an intra-operative endoscopy to help ensure a tight seal on the remnant stomach prior to completion of the procedure. During our endoscopy, a blood clot overlying a portion of the esophagus was noted, evacuated and evaluated and found to have a non-bleeding mucosal tear. This was unusual in our experience. There was no leak found on intra-operative endoscopy. After the patient woke up, she starting to have bouts of hematemesis. The decision was made to go back to the OR and evaluate her endoscopically. rather than attempting a laparoscopy based off of our endoscopic findings. Upon take back, we found a mucosal tear in her distal esophagus that now started bleeding, and her staple line was intact. Hemostasis was successfully achieved with two epinephrine injections. The remaining portion of her postoperative course was uncomplicated. Discussion and conclusions:The patient was able to be safely managed with a post-operative EGD. The intraoperative endoscopic findings allowed us to be more confident that this was an esophageal issue rather than a staple line problem, and were able to start with EGD prior to laparoscopy. Additionally, from a visualization perspective, the intra-operative endoscopy allows you to fully visualize the staple line, evaluate for twists or narrowing, and test for leak with confidence. From a residency standpoint, it also increases the confidence of residence to perform endoscopy on intubated patients.

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Section: Discussionmentioning

confidence: 77%

Benefits of Intraoperative Endoscopy: Case Report and Review of 300 Sleeves Gastrectomies

Ameer¹

2015

Obesity

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“…Published guidelines from the European Association for Endoscopic Surgery (EAES) in 2005 and the American Society of Gastroenterology (ASGE) in 2008 recommended that upper gastrointestinal endoscopy should be performed in all symptomatic patients undergoing bariatric surgery, and considered in all candidates [1,2]. However, the rationale for using routine endoscopy in asymptomatic patients before bariatric surgery remains contentious [3][4][5][6][7][8][9][10]. Several authors have now documented the lack of correlation between patient symptoms and endoscopic findings and have suggested that routine preoperative endoscopy might in fact be useful in detecting both lesions and inflammation [11,12].…”

Section: Introductionmentioning

confidence: 99%

Should endoscopy be routinely performed for bariatric surgery candidates?

Çaycı¹,

Erdoğdu²,

Karaman³

et al. 2016

Eur Res J

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Objectives. The rationale for a routine endoscopy before bariatric surgery in asymptomatic patients remains controversial. The purpose of the present study was to compare, in a retrospective manner, the endoscopic findings of morbidly obese patients awaiting surgery with those of non-obese individuals. Methods. Between January 2014 and December 2014, preoperative endoscopic findings of 161 morbidly obese patients and 101 consecutive non-obese individuals were evaluated. Results. No significant differences were found between the two groups in terms of ulcer prevalence and the number of ulcers (p=0.120 and p=0.122, respectively). However, the frequency of bulbar ulcers was significantly higher in morbidly obese patients than in the nonobese (p=0.012). Furthermore, the ulcer activity score was significantly higher in morbidly obese patients (p=0.025). 84 patients underwent laparoscopic sleeve gastrectomy (LSG). Of those, 48 patients (57.1%) had Helicobacter pylori sero-positivity and 12 patients (14.3%) had peptic ulcer disease before surgery. H. pylori sero-positivity persisted in the resected gastric specimens of 33 patients (39.3%). Conclusion. The ulcer activation score in morbidly obese patients is higher -even when they are asymptomatic-than in non-obese individuals. Routine preoperative endoscopy should be considered in all bariatric surgery candidates to rule out pathologies such as hiatal hernia, extensive ulcers or malignant lesions which are the contraindications for a LSG.Eur Res J 2016;2(2):93-98

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“…It is recommended by several specialty societal guidelines, even in asymptomatic patients, to detect upper gastrointestinal abnormalities. (29)(30)(31)(32)(33) We used a 36 Fr bougie for sizing of the gastric sleeve. Marceau used a 60 Fr.…”

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confidence: 99%

Comparative Study Between Laparoscopic Sleeve Gastrectomy and Laparoscopic Mini Gastric Bypass for Treatment of Morbid Obesity.

Saad¹,

Hemida²,

Ashour³

et al. 2018

IJAR

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Background:Bariatric surgery proved to be the only successful treatment option leading to long-term weight loss with improvement of obesity related comorbidities. The Laparoscopic Sleeve Gastrectomy (LSG) is now one of the most popular bariatric procedure worldwide with rising prevalence over last decade, while the Mini Gastric Bypass (MGB) is now gaining some popularity as a relatively new bariatric procedure Methods:The study involved forty patients; twenty of them had Laparoscopic Sleeve Gastrectomy (LSG), and twenty of them had Laparoscopic Mini Gastric Bypass (MGB). The patients were selected according to National Institute of Health (NIH) guidelines. All procedures were performed by the same team of experienced bariatric surgeons. all the patients had a one-year period of follow up after surgery and were evaluated for weight loss, morbidity (early, and late), impact on obesity associated diseases and effect on quality of life (QoL). Results:The two groups were matched considering the demographic data. Operative time was significantly longer in MGB group (P = 0.001), with mean operative time in MGB group was 74.75, while in LSG group was 53.25 min. One patient (5%) from LSG group developed stenosis and was managed by endoscopic balloon dilatation. Mean excess weight loss % after one year was 66.99% (± 1.739%) for LSG group and 67.76% (± 1.813%) for MGB group. The QoL after one year was varied between good and very good in both groups, with 70% of LSG group lie in very good category, and 75% of MGB group lie in the very good category. Conclusion:Both studied laparoscopic techniques; LSG and MGB were safe and effective, with similar results as regards significant weight loss and improvement of obesity-associated medical comorbidities and quality of life, with acceptable morbidity.

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Routine Screening Endoscopy before Bariatric Surgery: Is It Necessary?

Cited by 43 publications

References 22 publications

Benefits of Intraoperative Endoscopy: Case Report and Review of 300 Sleeves Gastrectomies

Benefits of Intraoperative Endoscopy: Case Report and Review of 300 Sleeves Gastrectomies

Should endoscopy be routinely performed for bariatric surgery candidates?

Comparative Study Between Laparoscopic Sleeve Gastrectomy and Laparoscopic Mini Gastric Bypass for Treatment of Morbid Obesity.

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