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Background and study aims: Roux-Y Gastric Bypass is one of the most frequently used techniques in surgery for morbidly obese patients. Postoperative anatomy is altered by exclusion of the remnant stomach which makes this organ inaccessible for future Esophago-gastro-duodenoscopy (EGD). There is no consensus about preoperative assessment of the stomach. Some institutions choose to investigate the future remnant stomach by EGD, others do not. Aim of the present study is to quantify the yield of preoperative EGD in a bariatric center of excellence.

Methods: Patients, who were planned for laparoscopic Roux-Y Gastric Bypass (LRYGB) from December 2007 until August 2012, were all screened by EGD in advance. These files were retrospectively reviewed for EGD outcome, co-morbidities, medication and other patient characteristic. All these data were analyzed using a statistical program. A two sided P value of < 0.05 was considered statistically significant.

Results: 664 patients (m:f = 136:526; median age 44.2 years [range 18-66], average BMI 45.6 [range 33.1- 76.9]) underwent preoperative EGD. In 341 cases no abnormalities were found (A), 115 patients had findings that did not have consequences (B1), 112 patients needed HP eradication therapy (B2), 87 patients needed preoperative treatment by proton pump inhibitors (B3), and 6 patients needed follow up EGD prior to surgery (C). For one patient the operation was cancelled because preoperative EGD showed Barrett's esophagus with carcinoma (D). When all abnormalities are taken into account, baselines show a significant difference for age, gender, hypertension and alcohol consumption. The number of performed EGD's to find one serious abnormality (requiring a follow up EGD and/or postponing or cancelling the operation) is 94,5. The estimated costs of one EGD (including personnel costs but without sedation, admission and possible complications) is approximately 385 US dollar.

Conclusion: Based on our results and those in literature it can be concluded that routine assessment by EGD prior to laparoscopic Roux-Y Gastric Bypass should be abandoned. In this selected series, risk factors for abnormalities are age, gender, hypertension and alcohol consumption. The number of EGD's needed to perform to find one abnormality that requires treatment is high, with equal high costs.