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Ebrahimi SA, Karazhian E, Mesbah N, Mostafavian Z, Ghamari MJ, Dalili A, Mohammadzadeh HG, Mokhtari E, Mashoufi R, Zandbaf T. Upper Gastrointestinal Endoscopic Screening in Bariatric Surgery Candidates: Correlating the Findings with GERD symptoms. Obes Surg 2024:10.1007/s11695-024-07385-0. [PMID: 39028487 DOI: 10.1007/s11695-024-07385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 06/20/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION The role of routine preoperative esophagogastroduodenoscopy (EGD) in bariatric surgery candidates is controversial. This study compares preoperative EGD outcomes with patient-reported gastroesophageal reflux disease (GERD) symptoms to determine if a case-based EGD is appropriate. PATIENTS AND METHODS A prospective cohort study was conducted from April 2022 through September 2023 in Mashhad, Iran. All patients underwent EGD. To assess GERD symptoms, we used the GERD-Health Related Quality of Life questionnaire. Patients were categorized into two groups: the asymptomatic group (GERD-HRQL = 0) and the symptomatic group (GERD-HRQL > 0). RESULTS A total of 165 patients were included, out of which 133 (80.6%) were in the symptomatic group and 32 (19.4%) were in the asymptomatic group. Esophagitis was present in 41 (24.8%) patients. There was no significant difference in the frequency of esophagitis (18.8% vs. 26.3%, p-value = 0.37), hiatal hernia (18.8% vs. 18.8%, p-value = 1.00), gastritis (56.3% vs. 63.9%, p-value = 0.42), and H. pylori infection (9.4% vs. 12.0%, p-value = 1.00) between the asymptomatic and symptomatic groups, respectively. None of the demographic factors or comorbidities of asymptomatic patients were associated with esophagitis, except for hiatal hernia (OR = 7.67, 95% CI 3.01-19.53, p-value < 0.001). Receiver operating characteristic (ROC) analysis showed that the GERD-HRQL total scores, as well as the heartburn and regurgitation subscales, were poor predictors of esophagitis (AUC 0.57, 0.51, and 0.56, respectively). CONCLUSION EGD findings were not associated with GERD symptoms in candidates for bariatric surgery.
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Affiliation(s)
- Seyed Ali Ebrahimi
- Student Research Committee, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
| | - Elahe Karazhian
- Department Of Medical-Surgical Nursing, Faculty of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narges Mesbah
- Student Research Committee, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
| | - Zahra Mostafavian
- Department of Community Medicine, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
| | - Mohammad Javad Ghamari
- Department of General Surgery, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
| | - Amin Dalili
- Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Elham Mokhtari
- Department of Internal Medicine, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
| | - Rasam Mashoufi
- Innovative Medical Research Center, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
| | - Tooraj Zandbaf
- Department of General Surgery, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran.
- Dr. Shahinfar Faculty of Medicine, Bazarche Sarab, Imam Khomeini 14, Mashhad, Iran.
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Vu TVT, Smith BC, Chen R, Narendra A, Brown W. Management of a Proximal and Distal Staple Line Leak Following Sleeve Gastrectomy and a Concurrent Duodenal Ulcer by Emergency Laparoscopic Conversion to a Roux-en-Y Gastric Bypass. Obes Surg 2024; 34:700-701. [PMID: 38110784 DOI: 10.1007/s11695-023-06997-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 12/20/2023]
Affiliation(s)
| | - Baxter Clyde Smith
- The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Richard Chen
- The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Aaditya Narendra
- The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Wendy Brown
- The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Centre for Obesity Research and Education, Monash University, Melbourne, VIC, Australia
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Doukas SG, Doukas PG, Vageli DP, Broder A. Gastric cancer after Bariatric Bypass Surgery. Do they relate? (A Systematic Review). Obes Surg 2023; 33:1876-1888. [PMID: 37041375 DOI: 10.1007/s11695-023-06567-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
Bariatric bypass surgery has been an effective treatment for morbid obesity. However, there is an increasing number of reported cases of gastric cancer after bypass surgery. Our systematic review showed an increasing trend of gastric cancer cases after bariatric bypass surgery in the last decade, mostly located in the excluded stomach (77%) and diagnosed in an advanced stage. In addition to known risk factors such as tobacco smoking (17%), H. pylori infection (6%), and family history of gastric cancer (3%), bile reflux, a recently proposed cancer-promoting factor, was also estimated in 18% of the cases. Our data suggest that gastric cancer risk assessment should be considered before gastric bypass surgery, and further investigations are needed to determine the value of post-operative gastric cancer surveillance.
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Affiliation(s)
- Sotirios G Doukas
- Department of Medicine, Division of Gastroenterology and Hepatology, Saint Peter's University Hospital/Rutgers-RWJ Medical School, 254 Easton Avenue, New Brunswick, NJ, 08901, USA.
| | - Panagiotis G Doukas
- Departmengt of Surgery, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Dimitra P Vageli
- Departmengt of Surgery, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Arkady Broder
- Department of Medicine, Division of Gastroenterology and Hepatology, Saint Peter's University Hospital/Rutgers-RWJ Medical School, 254 Easton Avenue, New Brunswick, NJ, 08901, USA
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Involvement of Helicobacter pylori in Preoperative Gastric Findings on a Bariatric Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159088. [PMID: 35897458 PMCID: PMC9332016 DOI: 10.3390/ijerph19159088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/16/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022]
Abstract
The prevalence of Helicobacter pylori (Hp) in bariatric patients is common and related to gastric pathology. With preoperative upper gastrointestinal endoscopy (UGE), these pathologies and the presence of Hp are diagnosed. The histopathological study of the UGE biopsies is classified based on the Sydney System, a scoring system that stages chronic gastritis (CG) and precancerous gastric lesions. The objective is to assess the histological findings of gastric biopsies during routine UGE and to determine the involvement of Hp in gastric disorders in patients undergoing bariatric surgery. A multicenter retrospective review of prospectively collected databases was performed. The presence of CG, gastric atrophy (GA), and gastric intestinal metaplasia (GIM) in the study of the biopsies was assessed and correlated with Hp infection. The incidence of Hp among our bariatric population was 36.1%, and it increases with age. The percentage of patients with severe Hp infection is higher in patients with GA or GIM. The Hp eradication rate is also reduced when GA and GIM are present. A histological examination of all the biopsies did not show features of malignancy in any of the cases. Hp is not the only factor involved in the development of gastric pathology in bariatric patients.
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Galloro G, Musella M, Siciliano S, Berardi G, Vitiello A, Velotti N, Rizzello F, Gionchetti P, Calabrese C. New endoscopic capsule vs upper gastrointestinal endoscopy in preoperative work-up of obese candidate for bariatric surgery: Relevance of a pilot study in the COVID-19 era. Endosc Int Open 2022; 10:E183-E191. [PMID: 35178336 PMCID: PMC8847058 DOI: 10.1055/a-1723-3109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background and study aims Obesity represents a major health concern; bariatric surgery is the most effective treatment reducing and maintaining weight loss. The role of a routine esophagogastroduodenoscopy (EGD) prior bariatric surgery is still debated. Moreover, in this scenario of COVID-19 pandemic, EGD is even more questionable due to the procedural risk of viral transmission. A new model of video-endoscopic capsule (VEC) recently has been introduced as a good alternative to the EGD. The aim of this study was to determine if this new capsule is an adequate diagnostic alternative to EGD in the work-up of patients selected for bariatric surgery, particularly in the setting of COVID-19. Patients and methods From January to November 2020, 27 patients selected for bariatric surgery were enrolled in this pilot study to assess for noninferiority of VEC compared to EGD in detection of upper gastrointestinal disease. Results VEC had sensitivity, specificity, and positive and negative predictive values in identification of significant lesions of 91.3 %, 83.33 %, 98.01 %, and 51.57 %, respectively, compared with EGD as the standard criterion. The accuracy was 90.51 % (95 % CI, 73.75 %-98.18 %) and the chi-square statistic is 0.1153 ( P = 0.73). Conclusions Our report confirms the diagnostic noninferiority of VEC in preoperative work-up of patients selected for bariatric surgery, compared to EGD. This is very important, particularly during the COVID-19 pandemic, given the high risk of contamination with EGD. Larger multicenter studies are required to confirm our preliminary results.
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Affiliation(s)
- Giuseppe Galloro
- University of Naples Federico II – School of Medicine, Department of Clinical Medicine and Surgery – Surgical Endoscopy Unit, Naples, Italy
| | - Mario Musella
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Saverio Siciliano
- University of Naples Federico II – School of Medicine, Department of Clinical Medicine and Surgery – Surgical Endoscopy Unit, Naples, Italy
| | - Giovanna Berardi
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Antonio Vitiello
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Nunzio Velotti
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Fernando Rizzello
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
| | - Paolo Gionchetti
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
| | - Carlo Calabrese
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
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IFSO Position Statement on the Role of Esophago-Gastro-Duodenal Endoscopy Prior to and after Bariatric and Metabolic Surgery Procedures. Obes Surg 2021; 30:3135-3153. [PMID: 32472360 DOI: 10.1007/s11695-020-04720-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
One of the roles of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) is to provide guidance on the management of patients seeking surgery for adiposity-based chronic diseases. The role of endoscopy around the time of endoscopy is an area of clinical controversy. In 2018, IFSO commissioned a task force to determine the role of endoscopy before and after surgery for the management of adiposity and adiposity-based chronic diseases. The following position statement is issued by the IFSO Endoscopy in Bariatric/Metabolic Surgery Taskforce. It has been approved by the IFSO Scientific Committee and Executive Board. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence. It will be reviewed regularly.
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Ooi GJ, Browning A, Hii MW, Read M. Perioperative screening, management, and surveillance of Barrett's esophagus in bariatric surgical patients. Ann N Y Acad Sci 2020; 1481:224-235. [PMID: 32794237 DOI: 10.1111/nyas.14441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/06/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022]
Abstract
Obesity is a strong risk factor for Barrett's esophagus (BE), the only proven precursor lesion to esophageal adenocarcinoma (EAC). Bariatric surgery is currently the only reliable treatment that achieves long-term sustained weight loss; however, it can markedly affect the development of de novo BE, and the progression or regression of existing BE. Bariatric procedures may also have implications on future surgical management of any consequent EAC. In this review, we examine the current evidence and published guidelines for BE in bariatric surgery. Current screening practices before bariatric surgery vary substantially, with conflicting recommendations from bariatric societies. If diagnosed, the presence of BE may alter the type of bariatric procedure. A selective screening approach prevents unnecessary endoscopy; however, there is poor symptom correlation with disease. Studies suggest that sleeve gastrectomy predisposes patients to gastroesophageal reflux and de novo BE. Conversely, Roux-en-Y gastric bypass is associated with decreased reflux and potential improvement or resolution of BE. There are currently no guidelines addressing the surveillance for BE following bariatric surgery. BE is an important consideration in the management of bariatric surgical patients. Evidence-based recommendations are required to guide procedure selection and postoperative surveillance.
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Affiliation(s)
- Geraldine J Ooi
- Department of Surgery, Central Clinical School, Monash University, Prahran, Victoria, Australia
| | - Alison Browning
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Michael W Hii
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia.,Department of Surgery, the University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Matthew Read
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia.,Department of Surgery, the University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia
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Prevalence of Endoscopic Findings Before Bariatric Surgery and Their Influence on the Selection of the Surgical Technique. Obes Surg 2020; 30:4375-4380. [PMID: 32588172 DOI: 10.1007/s11695-020-04800-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most popular procedures performed. The decision of which technique is most appropriate depends on the surgeon's preferences and experience. However, several factors strongly influence the decision of the procedure performed, including gastrointestinal disorders or asymptomatic upper gastrointestinal endoscopy (UGE) findings. This study aimed to describe the pathological endoscopic findings in morbidly obese patients undergoing preoperative routine UGE. MATERIALS AND METHODS A retrospective review of a prospectively collected database of all UGEs performed before bariatric surgery was performed. UGE was routinely performed to all the patients as part of the preoperative evaluation protocol. RESULTS A total of 790 patients were included. Surgical technique included 610 (77.2%) RYGB and 180 (22.8%) SG. Twenty-one asymptomatic patients presented esophagitis at UGE. In only seven patients (0.89%), the endoscopic findings of esophagitis had changed the initial surgical decision. The presence of ulcers or adenomatous or incompletely resected polyps was an indication for SG, to assure future endoscopic access in case it is needed. In 25 patients (3.17%), the initial operation would have been changed based on UGE findings. CONCLUSION Preoperative UGE allows the diagnosis of asymptomatic esophagitis related to gastroesophageal reflux disease and the identification of asymptomatic polyps and ulcers, with the potential ability for malignant transformation. In up to 3.17% of the cases, the endoscopic findings changed the operative strategy. As the complication rate associated with the procedure is low, we recommend the routine performance of preoperative UGE before bariatric surgery.
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Assalia A, Gagner M, Nedelcu M, Ramos AC, Nocca D. Gastroesophageal Reflux and Laparoscopic Sleeve Gastrectomy: Results of the First International Consensus Conference. Obes Surg 2020; 30:3695-3705. [PMID: 32533520 DOI: 10.1007/s11695-020-04749-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is probably the main drawback of laparoscopic sleeve gastrectomy (LSG). Herein, we critically discuss the issue and report the results of the first international consensus conference held in Montpellier, France, during June 2019. METHODS Fifty international bariatric experts from 25 countries convened for 2 days for interactive discussions, and to formulate the most relevant questions by electronically submitting 55 preliminary questions to panelists. Following the meeting, a final drafted questionnaire comprised of 41 questions was sent to all experts via e-mail. RESULTS Forty-six experts responded (92%). Esophago-gastro-duodenoscopy was considered mandatory before (92%) and after (78%) surgery. No consensus was achieved as to time intervals after surgery and the role of specialized tests for GERD. Higher degrees of erosive esophagitis (94%) and Barrett's esophagus (96%) were viewed as contra-indications for LSG. Roux-en-Y gastric bypass was recommended in postoperative patients with uncontrolled GERD and insufficient (84%) or sufficient (76%) weight loss and Barrett's esophagus (78%). Hiatal hernia (HH) repair was deemed necessary even in asymptomatic patients without GERD (80% for large and 67% for small HH). LSG with fundoplication in patients with GERD was considered by 77.3% of panelists. CONCLUSIONS The importance of pre- and postoperative endoscopy has been emphasized. The role of specialized tests for GERD and the exact surveillance programs need to be further defined. LSG is viewed as contra-indicated in higher degrees of endoscopic and clinical GERD. LSG with anti-reflux fundoplication emerges as a new valid option in patients with GERD.
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Affiliation(s)
- Ahmad Assalia
- Division of Advanced Laparoscopic and Bariatric Surgery, Department of General Surgery, Rambam Health Care Campus and the Technion Faculty of Medicine, 8 Haalia str, 3109601, Haifa, Israel.
| | - Michel Gagner
- Hôpital du Sacre Coeur, Montreal, Canada.,Herbert Wertheim School of Medicine, Miami, FL, USA
| | - Marius Nedelcu
- Centre de Chirurgie de l'Obesite (CCO), Clinique Bouchard, Marseille, France.,Centre de Chirurgie de l'Obesite (CCO), Clinique Saint Michel, Toulon, France
| | - Almino C Ramos
- Gastro-Obeso-Center Institute for Metabolic Optimization, Sao Paulo, Brazil
| | - David Nocca
- Bariatric Unit, CHU Montpellier, Institut de génomique fonctionnelle, CNRS, INSERM, University of Montpellier, Montpellier, France
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Preoperative Endoscopic and Radiologic Evaluation of Bariatric Patients: What Do They Add? J Gastrointest Surg 2020; 24:764-771. [PMID: 31073799 DOI: 10.1007/s11605-019-04219-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 03/27/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Preoperative esophagogastroduodenoscopy (EGD) and barium swallow (BS) are commonly performed for evaluation in bariatric surgery patients. The routine use of these modalities has been controversial. METHODS A retrospective review of a prospectively maintained database was performed to include primary bariatric surgery patients between March 2013 and August 2016. RESULTS Two hundred nine patients were included. All the patients underwent preoperative EGD and BS. The mean age was 43.12 years and BMI 46.4 kg/m2. Reflux symptoms were present in 58.5% of patients. Preoperative EGD revealed abnormalities in 87.5% of patients: esophagitis (54.5%), Barrett's esophagus (5.3%), dysplasia (1%), and gastritis (51%). Endoscopic evidence of HH was documented in 52.2% of patients while only 34% of patients had evidence of HH in their BS. Of the asymptomatic patients, 80.2% had abnormal EGD. Helicobacter pylori on biopsy was found in 17.2% patients, out of which 47.2% were asymptomatic. Based on EGD findings, the choice of surgical procedure was changed in 3.34% of patients. Repair of HH was performed in 107 patients, with 68.2% (n = 73) symptomatic patients and 31.8% (n = 34) asymptomatic patients. On ROC analysis, EGD was better predictive of the presence of HH (AUC = 0.802, OR 5.20, p = < 0.0001) and symptoms were a poor indicator for GERD. CONCLUSIONS Preoperative EGD is abnormal in the majority of patients regardless of their symptoms. EGD is the only modality that can provide tissue sample, which can potentially determine the type of bariatric surgery. Given the low diagnostic accuracy of BS, its routine use can be eliminated.
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Abstract
Introduction The role of preoperative upper-gastrointestinal (GI) gastroscopy has been discussed with controversy in bariatric surgery. The aim of this study was to evaluate the incidence of upper-GI pathologies detected via endoscopy prior to bariatric surgery along with their clinical significance for patients’ management. Material and Methods In our single center prospectively established database of obese patients, who underwent bariatric surgery from January 2011 to December 2017, we retrospectively analyzed the perioperative endoscopic findings along with their influence on patients’ management. Results In total, 636 obese patients with median BMI (body mass index) of 49 kg/m2 [range 31–92] received an upper-GI endoscopy prior to bariatric surgery. Among the surgical procedures, laparoscopic Roux-Y-gastric bypass (72.6%; n = 462) was the most frequent operation. Endoscopically detected pathological conditions were peptic ulcer 3.5% (22/636), Helicobacter pylori (Hp) gastritis 22.4% (143/636), and gastric or duodenal polyps 6.8% (43/636). Reflux esophagitis could be detected in 139/636 patients (21.9%). Barrett’s esophagus (BE) was histologically diagnosed in 95 cases (15.0%), whereas BE was suspected endoscopically in 75 cases (11.3%) only. Esophageal adenocarcinomas were detected in 3 cases (0.5%). Change of the operative strategy due to endoscopically or histologically detected pathologic findings had to be performed in 10 cases (1.6%). Conclusion Preoperative upper-GI endoscopy identifies a wide range of abnormal endoscopic findings in obese patients, which may have a significant impact on decision-making, particularly regarding the most suitable bariatric procedure and the appropriate follow-up. Therefore, preoperative upper-GI endoscopy should be considered in all obese patients prior to bariatric procedure.
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Endo Y, Ohta M, Tada K, Saga K, Takayama H, Hirashita T, Uchida H, Iwashita Y, Inomata M. Clinical significance of upper gastrointestinal endoscopy before laparoscopic bariatric procedures in Japanese patients. Surg Today 2018; 49:27-31. [DOI: 10.1007/s00595-018-1705-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/19/2018] [Indexed: 01/01/2023]
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Suumann J, Sillakivi T, Riispere Ž, Syrjänen K, Sipponen P, Kirsimägi Ü, Peetsalu A. Serological biomarker testing helps avoiding unnecessary endoscopies in obese patients before bariatric surgery. BMC OBESITY 2018; 5:9. [PMID: 29484193 PMCID: PMC5819710 DOI: 10.1186/s40608-018-0185-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/01/2018] [Indexed: 02/06/2023]
Abstract
Background To assess the value of serological biomarker testing as a substitute for esophagogastroduodenoscopy (EGDS) in pre-operative assessment of patients referred for bariatric surgery. Methods Sixty-five obese patients with a mean age of 43 years (range: 21–65) and a mean body mass index (BMI) of 44 (range: 36–59) were studied. The patients were tested with a four-biomarker panel: pepsinogen I and II, gastrin-17 (basal and stimulated), and Helicobacter pylori (HP) antibodies (GastroPanel®, Biohit Oyj, Finland). On the basis of the biomarker test, the patients were classified into the HS (healthy stomach) group (n = 22) with the normal biomarker profile and the NHS (non-healthy stomach) group (n = 43). The classification of patients into HS and NHS was evaluated against the gold standard, i.e. EGDS with biopsies. Results The concordance (Cohen’s kappa) between the biomarker test and gastric histology was 0.68; 95% CI 0.504–0.854, with an overall agreement of 84.6% (95% CI 73.9–91.4%). In the NHS group, all 43 patients had biopsy-confirmed chronic gastritis: 39 non-atrophic HP-gastritis, 4 atrophic antrum gastritis (AGA) of moderate severity. In the HS group only 6 patients had mild superficial H.pylori negative gastritis. Of the 22 HS subjects with the normal biomarker profile, 20 (31% of all 65) had no complaints either, while the remaining two had reflux symptoms with esophagitis. In the NHS group 10 patients had esophagitis and 8 had also reflux symptoms. Conclusions The normal biomarker profile is an excellent surrogate for healthy stomach, implicating that pre-operative EGDS could have been avoided in 31% of our asymptomatic bariatric surgery patients who had the normal biomarker profile.
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Affiliation(s)
- Jaanus Suumann
- 1Department of Surgery, University of Tartu, Tartu, Estonia
| | | | - Živile Riispere
- 2Department of Pathology, University of Tartu, Tartu, Estonia
| | - Kari Syrjänen
- Department of Clinical Research, Biohit Oyj, Helsinki, Finland
| | | | - Ülle Kirsimägi
- 1Department of Surgery, University of Tartu, Tartu, Estonia
| | - Ants Peetsalu
- 1Department of Surgery, University of Tartu, Tartu, Estonia
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Wolter S, Duprée A, Miro J, Schroeder C, Jansen MI, Schulze-Zur-Wiesch C, Groth S, Izbicki J, Mann O, Busch P. Upper Gastrointestinal Endoscopy prior to Bariatric Surgery-Mandatory or Expendable? An Analysis of 801 Cases. Obes Surg 2018; 27:1938-1943. [PMID: 28243860 DOI: 10.1007/s11695-017-2622-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Upper gastrointestinal pathologies are common in bariatric patients. Preoperative esophagogastroduodenal endoscopy (EGD) should detect and treat pathologies that might alter the type of bariatric surgery. However, clinical consequences of these findings are often insignificant. The aim of this study was to assess the influence of preoperative endoscopy in our cohort and its clinical consequences. METHODS We conducted a retrospective analysis of endoscopic findings in patients under evaluation for bariatric surgery. Endoscopic findings were compared to preoperative risk factors as well as postoperative complications, and its clinical consequences were analyzed. RESULTS Data was available for 801 patients. Abnormal endoscopic findings were found in 65.7% of all patients. The most common conditions were gastritis (32.1%) and gastroesophageal reflux (24.8%). Malignancies were observed in 0.5% of all patients. We observed early-stage adenocarcinoma of the esophagus in two patients through our routine preoperative evaluation. Helicobacter pylori infections were detected in preoperative biopsies in only 3.7% of all patients. Patients who reported reflux symptoms had a higher rate of pathological EGDs (74.2 vs. 64.9%, p .019). We did not find any other risk factors for a pathological endoscopy. The postoperative complication rate was 11.2%. Leakage rate was 1.1%. Mortality rate was 0.4%. We did not find any correlation between the incidence of postoperative complications and preoperative endoscopic findings. CONCLUSIONS Relevant findings in routine preoperative endoscopy are rare but have significant influence on decision-making in bariatric patients and should be assessed as a necessary diagnostic tool.
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Affiliation(s)
- Stefan Wolter
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Anna Duprée
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jameel Miro
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Cornelia Schroeder
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Marie-Isabelle Jansen
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | | | - Stefan Groth
- Department of Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Oliver Mann
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Philipp Busch
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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15
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Rare Entities of Histopathological Findings in 755 Sleeve Gastrectomy Cases: a Synopsis of Preoperative Endoscopy Findings and Histological Evaluation of the Specimen. Obes Surg 2017; 28:1289-1295. [DOI: 10.1007/s11695-017-3014-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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16
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Abstract
A substantial decrease in Helicobacter pylori-associated peptic ulcer disease has been observed during the last decades. Drug-related ulcers as well as idiopathic ulcers are becoming predominant and are more refractory to treatment; however, H. pylori infection still plays an important role in ulcer bleeding and recurrence after therapy. The effect of H. pylori eradication upon functional dyspepsia symptoms has been reviewed in this article and generally confirms the results of previous meta-analyses. Additional evidence suggests a lack of impact upon the quality of life, in spite of improvement in symptoms. The association of H. pylori with gastroesophageal reflux disease and Barrett's esophagus remains controversial with a majority of published studies showing a negative association. Furthermore, a strong inverse relationship between the presence of H. pylori and the esophageal eosinophilia was also reported. Several studies and a review addressed the role of H. pylori in autoimmune gastritis and pernicious anemia. The association of the above still remains controversial. Finally, the necessity of routine endoscopy and H. pylori eradication before bariatric surgery is discussed. Several studies suggest the rationale of preoperative upper endoscopy and H. pylori eradication prior to surgery. However, the prevalence of H. pylori infection prior to surgery in these studies generally reflects the overall prevalence of the infection in the particular geographic area. In addition, results on the role of H. pylori in developing postoperative complications remain controversial.
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Affiliation(s)
- Olga Sjomina
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia.,Riga East University Hospital, Riga, Latvia
| | - Frederic Heluwaert
- Hepato-gastroenterology department, Annecy Genevois Hospital, Pringy, France
| | - Driffa Moussata
- Gastroenterology department, Tours University Hospital, Tours, France
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia.,Riga East University Hospital, Riga, Latvia.,Digestive Diseases Centre GASTRO, Riga, Latvia
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17
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Gastric carcinoma after sleeve gastrectomy for obesity. Surg Obes Relat Dis 2017; 13:1459-1461. [DOI: 10.1016/j.soard.2017.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/08/2017] [Accepted: 04/12/2017] [Indexed: 12/16/2022]
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18
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