SSAT - National Trends in Intra-Operative Endoscopy During Laparoscopic Roux-en-Y Gastric Bypass

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National Trends in Intra-Operative Endoscopy During Laparoscopic Roux-en-Y Gastric Bypass
John N. Afthinos^*, Roman Grinberg, Karen E. Gibbs
Staten Island University Hospital, Staten Island, NY

Introduction: The routine use of intra-operative endoscopy (IOE) during laparoscopic Roux-en-Y gastric bypass (LRYGB) has been discussed in the literature and is supported at national and international surgical society meetings. Some of the potential benefits that have been demonstrated are: (1) sensitive leak tests and (2) early detection and management of operative bleeding. We wished to evaluate the utilization and trends of intra-operative endoscopy during LRYGB using a large national database.
Methods: The National Inpatient Sample (NIS) Database was queried from 2005 - 2010 for all patients undergoing elective primary LRYGB. We identified those patients who underwent concomitant endoscopy. An annual trend of utilization was performed. Age, gender, comorbid conditions and in-hospital post-operative complications were evaluated. Multivariate regression analyses were performed to evaluate any reduction in post-operative complications as a result of performing an IOE.
Results: A total of 366,098 LRYGB were performed during the study period. Of these, 6,957 underwent IOE (2%). The LRYGB + EGD group was significantly younger (42.7 + 11.2 vs. 43.7 + 11.2, p < 0.0001) and had a significantly high proportion of men (22% vs. 19.7%, p < 0.05). The peak utilization was in 2007 (2.8%) with a nadir in 2010 (1.2%--Table 1). Multivariate regression analysis revealed that LRYGB + EGD was associated with a decreased risk for post-operative hemorrhage (OR 0.7, p < 0.005), cardiac complications (OR 0.6, p < 0.004) and renal failure (OR0.3, p < 0.002).
Discussion: The overall utilization of IOE during LRYGB is low at 2%. The lowest rate (1.2%) was in 2010. Post-operative hemorrhage is reduced when endoscopy is performed. IOE has a role in the armamentarium of the bariatric surgeon and should be considered.

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