Is Preoperative Upper Gastrointestinal Endoscopy (egd) Relevant Preceding Bariatric Surgery?
*Amit Thour, *Raman Krimpuri, *Charles Thomas, *Eileen Seeholzer, Sergio Bardaro
Metrohealth Medical Center, Cleveland, OH
Objective: Routine upper endoscopy (EGD) prior to bariatric surgery remains debatable, however it may provide relevant information that could impact the appropriate procedure selection: Sleeve Gastrectomy (SG) vs. Roux-en Y Gastric Bypass (RYGB)/Long Limb Gastric Bypass (LLRYGB). Previous published data is highly variable on rates of surgical plan alteration based on EGD. This project aimed to evaluate how often information from pre-operative EGD would alter a planned bariatric procedure.
Method: We conducted a retrospective analysis of electronic medical record (EMR) data from March 2015- January 2019 for patients who had an EGD in preparation for bariatric surgery. Study was approved by Institutional Review Board (IRB#19-00164). Demographics, EGD findings and alterations in planned surgery from pre-EGD plan were analyzed using Chi square and Contingency Coefficient for categorical variables, and Wilcoxon Non-parametric test for continuous variables.
386 patients had a pre-operative EGD. Patients mean age was 46.5 years; were 86% female; and mean BMI of 48.5. EGD results had pathologic findings in 206 patients (53.4%). Findings were associated with older age (p=0.0079). Of 206 patients with pathologic findings in the EGD, planned procedure changed in 30 patients (14.6% p=0.72). Planned SG was changed to RYGB/LLRYGB in 14(9.79%) and RYGB/LLYGB changed to SG in 16(25.40%).
No statistical difference was found between bariatric procedure plan before and after EGD. However, patients who did have a change in procedure plan to lower the risk for undesirable outcomes would not have been detected without this evaluation. This data shows higher rate of post-EGD procedure change than previous studies. Routine preoperative EGD may still be controversial, but it can provide relevant information for adequate planning in bariatric surgery patients.
Table 1. Demographics and endoscopic findings
|Positive endoscopic findings|
|Negative endoscopic findings|
|Age (years)||47.73(SD 9.62)||45.11(SD 10.70)||0.0079|
|Weight (pounds)||284.33(SD 56.55)||293.12(SD 60.78)||0.3195|
|BMI||49.11(SD 22.95)||47.78(SD 8.5)||0.827|
Table 2. Alteration of planned procedure based on endoscopic findings
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