Should endoscopy be routinely performed for bariatric surgery candidates?

Year 2016, Volume: 2 Issue: 2, 93 - 98, 04.07.2016

Haci Murat Cayci , Umut Eren Erdogdu , Kerem Karaman , Evren Dilektasli , Taskin Erkinuresin

https://doi.org/10.18621/eurj.2016.5000183237

Abstract

Objectives. The rationale for a routine endoscopy before bariatric surgery in asymptomatic patients remains controversial. The purpose of the present study was to compare, in a retrospective manner, the endoscopic findings of morbidly obese patients awaiting surgery with those of non-obese individuals. Methods. Between January 2014 and December 2014, preoperative endoscopic findings of 161 morbidly obese patients and 101 consecutive non-obese individuals were evaluated. Results. No significant differences were found between the two groups in terms of ulcer prevalence and the number of ulcers (p=0.120 and p=0.122, respectively). However, the frequency of bulbar ulcers was significantly higher in morbidly obese patients than in the non-obese (p=0.012). Furthermore, the ulcer activity score was significantly higher in morbidly obese patients (p=0.025). 84 patients underwent laparoscopic sleeve gastrectomy (LSG). Of those, 48 patients (57.1%) had Helicobacter pylori sero-positivity and 12 patients (14.3%) had peptic ulcer disease before surgery. H. pylori sero-positivity persisted in the resected gastric specimens of 33 patients (39.3%). Conclusion. The ulcer activation score in morbidly obese patients is higher -even when they are asymptomatic- than in non-obese individuals. Routine preoperative endoscopy should be considered in all bariatric surgery candidates to rule out pathologies such as hiatal hernia, extensive ulcers or malignant lesions which are the contraindications for a LSG.

Keywords

Morbidly obesity, laparoscopic sleeve gastrectomy, Helicobacter pylori, peptic ulcer

References

• Sauerland S, Angrisani L, Belachew M, Chevallier JM, Favretti F, Finer N, et al. European Association for Endoscopic Surgery. Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 2005;19:200-21.
• Anderson MA, Gan SI, Fanelli RD, Baron TH, Banerjee S, Cash BD, et al. (ASGE STANDARDS OF PRACTICE COMMITTEE). Role of endoscopy in the bariatric surgery patient. Gastrointest Endosc 2008;68:1-10.
• Madan AK, Speck KE, Hiler ML. Routine preoperative upper endoscopy for laparoscopic gastric bypass: is it necessary? Am Surg 2004;70:684-6.
• Korenkov M, Sauerland S, Shah S, Junginger T. Is routine preoperative upper endoscopy in gastric banding patients really necessary? Obes Surg 2006;16:45-7.
• Azagury D, Dumonceau JM, Morel P, Chassot G, Huber O. Preoperative work-up in asymptomatic patients undergoing Roux-en-Y gastric bypass: is endoscopy mandatory? Obes Surg 2006;16:1304-11.
• Loewen M, Giovanni J, Barba C. Screening endoscopy before bariatric surgery: a series of 448 patients. Surg Obes Relat Dis 2008;4:709-12.
• Kuper MA, Kratt T, Kramer KM, Zdichavsky M, Schneider JH, Glatzle J, et al. Effort, safety, and findings of routine preoperative endoscopic evaluation of morbidly obese patients undergoing bariatric surgery. Surg Endosc 2010;24:1996-2001.
• Peromaa-Haavisto P, Victorzon M. Is routine preoperative upper GI endoscope needed prior to gastric bypass? Obes Surg 2013;23:736-9.
• De Palma GD, Forestieri P. Role of endoscopy in the bariatric surgery of patients. World J Gastroenterol 2014;20:7777-84.
• Gomez V, Bhalla R, Heckman MG, Florit PT, Diehl NN, Rawal B, et al. Routine screening endoscopy before bariatric surgery: Is it necessary? Bariatr Surg Pract Patient Care 2014;9:143-9.
• Csendes A, Burgos AM, Smok G, Beltran M. Endoscopic and histologic findings of the foregut in 426 patients with morbid obesity. Obes Surg 2007;17:28-34.
• Munoz R, Ibanez L, Salinas J, Escalona A, Perez G, Pimentel F, et al. Importance of routine preoperative upper GI endoscopy: why all patients should be evaluated? Obes Surg 2009;19:427-31.
• Wu MS, Lee WJ, Wang HH, Huang SP, Lin JT. A case-control study of association of Helicobacter pylori infection with morbid obesity in Taiwan. Arch Intern Med 2005;165:1552-5.
• Erim T, Cruz-Correa MR, Szomstein S, Velis E, Rosenthal R. Prevalence of Helicobacter pylori seropositivity among patients undergoing bariatric surgery: a preliminary study. World J Surg 2008;32:2021-5.
• Gould J. Prevalence of Helicobacter pylori infection among patients undergoing bariatric surgery: a preliminary study. World J Surg 2008;32:2026-7.
• Gerig R, Ernst B, Wilms B, Thurnheer M, Schultes B. Preoperative nutritional deficiencies in severely obese bariatric candidates are not linked to gastric Helicobacter pylori infection. Obes Surg 2013;23:698-702.
• Verma S, Sharma D, Kanwar P, Sohn W, Mohanty SR, Tortolani AJ, et al. Prevalence of Helicobacter pylori infection in bariatric patients: a histologic assessment. Surg Obes Relat Dis 2013;9:679-85.
• Almazeedi S, Al-Sabah S, Alshammari D, Alqinai S, Al-Mulla A, Al-Murad A, et al. The impact of Helicobacter pylori on the complications of laparoscopic sleeve gastrectomy. Obes Surg 2014;24:412-5.
• Hartin CW Jr, ReMine DS, Lucktong TA. Preoperative bariatric screening and treatment of Helicobacter pylori. Surg Endosc 2009;23:2531-4.
• Cerqueira RM, Correia MR, Fernandes CD, Vilar H, Manso MC. Cumulative Helicobacter pylori eradication therapy in obese patients undergoing gastric bypass surgery. Obes Surg 2013;23:145-9.
• Ozden A, Dumlu S, Donderci O, Cetinkaya H, Soylu K, et al. Helicobacter pylori infeksiyonunun ulkemizde seroepidemiyolojisi. Gastroenteroloji 1992;3:664-8.