Routine surveillance endoscopy before and after sleeve gastrectomy?

Abstract

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.

Gastric Schwannoma In a Patient Undergoing Sleeve Gastrectomy: Uncommon Gastric Tumor Discovered Incidentally During a Common Gastric Procedure

“…In the present case, schwannoma was diagnosed incidentally during the operation, which led to cancelation of the procedure. Although the role of upper endoscopy prior to bariatric surgeries is controversial, many surgeons advocate its routine use among these patients as it can help in the selection of bariatric procedures appropriate to the patient [ 4 ]. For example, the use of restrictive bariatric procedures might worsen gastroesophageal reflux disease, if present.…”

“…Although comprehensive preoperative assessment is essential for patients undergoing sleeve gastrectomy, performing upper endoscopy routinely prior to the operation is a matter of debate [ 4 ]. Herein, we describe a case of gastric schwannoma, an uncommon type of gastric neoplasm, discovered incidentally in a patient scheduled for a sleeve gastrectomy procedure.…”

Gastroesophageal Reflux Disease in Obesity: Bariatric Surgery as Both the Cause and the Cure in the Morbidly Obese Population

“…As discussed above, some studies have proposed endoscopic surveillance post-bariatric surgery to assess disease progression to Barrett's esophagus and esophageal adenocarcinoma [147][148][149]. Endoscopy prior to bariatric surgery and obtaining a thorough history regarding gastroesophageal reflux symptoms may improve patient selection for bariatric surgery [135].…”

Training in bariatric and metabolic endoscopy

“…In addition, IFSO guidelines recommend a routine surveillance endoscopy after SG as the presence of esophagitis and de novo Barrett's esophagus after SG reaches 15-17%, and symptoms of gastroesophageal reflux disease (GERD) alone are not reliable. 34 POE is also essential before revisional bariatric surgery to evaluate causes of failure of the initial procedure and to dictate the operative strategy.…”

“…In addition, IFSO guidelines recommend a routine surveillance endoscopy after SG as the presence of esophagitis and de novo Barrett’s esophagus after SG reaches 15–17%, and symptoms of gastroesophageal reflux disease (GERD) alone are not reliable. 34…”