2005 Abstracts: Preoperative Endoscopy in Patients Undergoing Roux-En-Y Gastric Bypass for Morbid Obesity: Is it Necessary?
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Preoperative Endoscopy in Patients Undergoing Roux-En-Y Gastric Bypass for Morbid Obesity: Is it Necessary?
George Kazantsev, First Surgical Consultants, Oakland, CA
BACKGROUND. Roux-en Y gastric bypass is considered by many to be the gold standard procedure for morbid obesity. The main disadvantage of it is the lack of access to the distal stomach. Bleeding, perforated ulcer, and gastric cancer of the remnant have been reported. The extent of preoperatve evaluation of the stomach is not agreed upon and ranges from no evaluation at all to routine upper endoscopy. We have reviewed our one year experience with preoperative endoscopy in patients undergoing RYGBP.
METHODS. The results of upper endoscopies performed on 81 patents (pts) undergoing RYGBP were reviewed. All studies were done by 2 operating surgeons. Mucosal biopsies were obtained from the gastric antrum regardless of gross findings. The specimens were evaluated with H&E and specialized H. pylori stain. RESULTS. There were 72 women and 9 men of mean age of 43.7 (range 19-66) years and mean BMI of 46 (range 38-77). Gastritis was the most common finding (47% of all pts), with 10 cases (12.3%) described as "severe". Hiatal hernias were found in 35% of pts; 4 of them were large and required repair. Other findings included Grade II esophagitis in 6 pts (7.4%), Barrett's esophagus in 2 (2.5%), gastric ulcer in 1 patient (1.2%), multiple fundic gland polyps in 3 (3.7%). Pathology revealed mild chronic gastritis in 41 pts (50.6%) and severe gastritis in 17 (20.9%). Stains were positive for H.pylori in 14 cases (17.3%). Overall, the endoscopy results influenced our treatment approach in 21 cases (25.9%). Those included treatment of H.pylori or severe errosive gastritis/ulcer, addition of crural repair in pts with large hiatal hernia, selection of alternate procedures in pts with fundic gland polyps to preserve access to the distal stomach (sleeve gastrectomy in 2 and lap band in 1 case). CONCLUSION. Routine upper endoscopy in patients undergoing RYGBP for morbid obesity is associated with a relatively high incidence of clinically signifficant findings. The most common pathology is H.pylori gastritis. Findings such as multiple fundic gland polyps and large hiatal hernias may necessitate a change in the operative approach. Preoperative endoscopy should be strongly considered while evaluating a patient for possible gastric bypass surgery.
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