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Introduction: The role of routine esophagogastroduodenoscopy (EGD) prior to bariatric surgery remains controversial. The purpose of this study was to compare the diagnostic yield of preoperative EGD in morbidly obese patients when selective vs. routine approach is used. We also aimed to compare the diagnostic yield in asymptomatic and symptomatic patients. Methods: Review of an IRB approved, prospective database of all patients undergoing laparoscopic gastric bypass or banding at our institution between 2005 and 2009 by three bariatric surgeons who used different approaches to preoperative EGD was performed. Preoperative gastrointestinal symptoms (reflux, dysphagia, chronic pain) and indications for EGD were examined, and findings at preoperative EGD were recorded. The diagnostic yield of the procedure was compared between patients who had the procedure selectively and those who had it routinely. In addition, the yield of the procedure was compared between asymptomatic and symptomatic patients. The chi square test was used for comparisons. Results: Of 918 identified patients, 693 (75.5%) had undergone preoperative EGD. Reflux was the most prevalent indication leading to EGD (92.6%) followed by anemia in 15% of patients. The selective approach yielded a higher detection rate for gastric polyps and esophagitis but a lower detection rate for gastritis (table 1). Asymptomatic patients had a similar incidence of findings in comparison to those who had gastrointestinal symptoms or other indications for EGD (table 1). Conclusions: Preoperative EGD yields abnormal findings in at least 50% of morbidly obese patients considering weight loss surgery whether symptomatic or not. A selective approach to preoperative EGD may have a higher yield for gastric polyps and esophagitis compared to the routine approach but both have a similar overall yield of abnormal findings. Further study of the role of preoperative EGD in bariatric patients is needed and is currently underway.
Table 1: Prevalence of EGD findings by routine or selective EGD and by presence of symptoms

	Routine (%) n=439	Selective (%) n=254	p-value	Asymptomatic (%) n = 143	Symptomatic (%) n = 506	p-value
Normal	45.7	44.5	0.8014	50.3	43.5	0.1316
Hiatal Hernia	15.0	20.5	0.0836	10.5	18.6	0.0946
Gastritis	30.3	19.7	0.0030	24.5	27.5	0.2536
Esophagitis	13.2	19.3	0.0429	10.5	16.6	0.2032
Barrett’s	0.4	2.3	0.0581	0.7	1.4	0.8988
Ulcer	3.2	3.5	0.9772	2.8	3.2	0.9753
Polyps	3.4	10.6	0.0002	1.4	6.7	0.0830