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PREVALENCE OF PRE-OPERATIVE ENDOSCOPIC FINDINGS FOR SLEEVE GASTRECTOMY PATIENTS
Alejandro Pantoja Aguirre, Habib Khoury, Homero Rivas, John M. Morton*
Surgery, Stanford School of Medicine, Stanford, CA
Background: Obesity has become a national epidemic and its rates continue to rise. Currently, the primary effective long-term treatment for obesity is bariatric surgery. One of the most common procedures in bariatric surgery is the laparoscopic sleeve gastrectomy (LSG). Preoperatively, many LSG undergo a screening esophagogastroduodenoscopy (EGD). However, there are little data regarding the prevalence of significant findings in LSG patients at pre-operative evaluation. Preoperative EGD findings may influence choice of operation given the increased prevalence of gastro-esophageal reflux disease in post-operative LSG patients. This study attempts to determine the prevalence of EGD findings.
Methods: A retrospective chart review of the electronic medical records of patients who underwent screening EGD in preparation for LSG between 2008 and 2016 and the Stanford University Medical Center (SUMC was performed). We determined the prevalence of clinically significant findings by evaluating clinical, endoscopic, and pathological data.
Results: Two hundred and four (204) records were identified for patients who underwent EGD prior to LSG. Of those patients, 161 (79%) were female and 102 (50%) were Caucasian. Average age was 45 ± 12.39 years and average body mass index was 44 ± 6.54 kg/m2. Of the 204 patients, 26 patients (12.7%) had findings at EGD we considered clinically significant. Significant findings included Barrett’s esophagus (1.5%), erosive esophagitis (1.5%), ulcers (2.5%), strictures (0.5%), masses (1.9%), non-small hiatal hernias (0.98%), erosive gastritis (0.5%), gastroparesis (0.5%), polyps (5.4%), duodenitis (3%), and esophageal candidiasis (0.5%). In addition, 10% of patients tested positive through Alcian blue, rapid urease, or urea breath test.
Conclusions: Review of 204 patient records reveals that of those who underwent EGD in preparation for SG, 26 (12.7%) of patients had clinically significant findings that influenced choice of operation. Of note, one patient had esophageal candidiasis that was undiagnosed prior to EGD. The rate of findings is similar to that of our previous study on EGDs prior to laparascopic Roux-en-Y gastric bypass. The conclusion stands that EGD can be a helpful assessment in preparation of bariatric surgery.
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