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Allotey J, Caposole M, Attia A, Coonan E, Noguera V, Lewis E, Bloomenthal MS, Issa P, Omar M, Aboueisha M, Crisp B, Baker J, Levy S, Galvani C. GERD-screening before bariatric surgery: the predictive value of the GERD-HRQL questionnaire score compared with preoperative EGD findings. Surg Endosc 2023; 37:9572-9581. [PMID: 37730853 DOI: 10.1007/s00464-023-10388-0] [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: 05/09/2023] [Accepted: 08/12/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND There is an ongoing debate on how to best identify patients with gastroesophageal reflux disease (GERD) before bariatric surgery. The value of routine preoperative esophagogastroduodenoscopy (EGD) is questioned, and patient reported symptoms are commonly used for screening. The goal of this study is to determine if patient reported symptoms using a validated questionnaire correlate with preoperative EGD findings. METHODOLOGY A prospective cohort study at a single institution was performed. Patients undergoing bariatric surgery between December 2020 and March 2023 were required to report symptoms of reflux by completing a preoperative GERD. Health-Related Quality of Life (GERD-HRQL) questionnaire and undergo a mandatory preoperative screening EGD. Patients were stratified into two cohorts: (group A) asymptomatic (score = 0) and (group B) symptomatic (score > 0). Statistical analysis was conducted using Pearson's chi-squared test and Wilcoxon rank-sum test in RStudio version 4.2.2. The predictive value of the GERD-HRQL score was analyzed using Areas Under the Curve (AUC; AUC = 0.5 not predictive, 0.5 < AUC ≥ 6 poor prediction & AUC > 0.9 excellent prediction) calculated from Receiver Operating Characteristic (ROC) curves. RESULTS 200 patients were included; median age was 42.0 years (IQR 36.0 to 49.2). There were 79 patients (39.5%) in Group A and 121 patients (60.5%) in Group B. There was no difference in the frequency esophagitis (27.8% vs 32.2%, p = 0.61) or hiatal hernias (49.4% vs 47.1%, p = 0. 867) between group A and group B, respectively. ROC analysis revealed that the total GERD HRQL scores, heartburn only scores and regurgitation only scores, were poor predictors of esophagitis found on EGD (AUC 0.52, 0.53, 0.52), respectively. In asymptomatic patients, higher BMI was significantly associated with esophagitis (OR 1.15, 95% CI 1.06-1.27, p = 0.002). CONCLUSION Symptoms, identified through the GERD-HRQL questionnaire, are a poor indicator of esophagitis or its severity in patients undergoing workup for bariatric surgery. Therefore, liberal screening upper endoscopy is recommended for pre-bariatric surgery patients to guide appropriate procedure selection.
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Affiliation(s)
- Jonathan Allotey
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Michael Caposole
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Abdallah Attia
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Erin Coonan
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Valeria Noguera
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Emma Lewis
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Molly S Bloomenthal
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Peter Issa
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Mahmoud Omar
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Mohamed Aboueisha
- Division of Otolaryngology- Head and Neck Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Benjamin Crisp
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - John Baker
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Shauna Levy
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Carlos Galvani
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA.
- Division of Minimally Invasive Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
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Muir D, Choi B, Holden M, Clements C, Stevens J, Ratnasingham K, Irukulla S, Humadi S. Preoperative Oesophagogastroduodenoscopy and the Effect on Bariatric Surgery: a Systematic Review and Meta-Analysis. Obes Surg 2023; 33:2546-2556. [PMID: 37314649 DOI: 10.1007/s11695-023-06680-6] [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: 04/26/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Abstract
Preoperative oesophagogastroduodenoscopy (OGD) in bariatric surgery remains a controversial topic, with a large variety in practice globally. An electronic database search of Medline, Embase and PubMed was performed in an aim to categorise the findings of preoperative endoscopies in bariatric patients. A total of 47 studies were included in this meta-analysis resulting in 23,368 patients being assessed. Of patients assessed, 40.8% were found to have no novel findings, 39.7% had novel findings which did not affect surgical planning, 19.8% had findings that affected their surgery and 0.3% were ruled to not be suitable for bariatric surgery. Preoperative OGD is altering surgical planning in one-fifth of patients; however, further comparative studies are required to determine if each patient should undergo this procedure especially if asymptomatic.
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Affiliation(s)
- Duncan Muir
- Ashford and St Peter's Hospitals NHS Trust, Chertsey, UK.
| | - Byung Choi
- Ashford and St Peter's Hospitals NHS Trust, Chertsey, UK
| | - Matthew Holden
- Maxwell Institute, University of Edinburgh and Heriot-Watt University, Edinburgh, UK
| | | | | | | | | | - Samer Humadi
- Ashford and St Peter's Hospitals NHS Trust, Chertsey, UK
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Aljaroudi ME, Makki M, Almulaify M, Alshabib A, Alfaddagh H, Alzahrani H, Alghamdi S, Alsualiman W, Alsalman J, Alhaddad MJ. Endoscopic Assessment Prior to Bariatric Surgery in Saudi Arabia. Cureus 2023; 15:e36157. [PMID: 37065321 PMCID: PMC10101814 DOI: 10.7759/cureus.36157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND There are marked local inconsistencies in the Arabian Peninsula about the role of preoperative esophagogastroduodenoscopy (EGD) in bariatric surgery. Thus, this study was conducted to determine the frequency of endoscopic and histological findings in the Saudi population presenting for pre-bariatric surgery evaluation. MATERIAL AND METHODS This was a retrospective study that included all the patients who were evaluated by EGD at Dammam Medical Complex, Dammam, Saudi Arabia, between 2018 and 2021 as a part of their pre-bariatric-surgery evaluation. RESULTS A total of 684 patients were included. They consisted of 250 male and 434 female patients (36.5% and 63.5%, respectively). The mean ± standard deviation for the patients' age and body mass index (BMI) were 36.4±10.6 years and 44.6±5.1 kg/m2, respectively. Significant endoscopic or histopathological findings as defined by the presence of large (≥ 2 cm) hiatus hernia, esophagitis, gastroesophageal reflux disease (GERD), Barrett esophagus, gastric ulcer, duodenal ulcer, or intestinal metaplasia were found in 143 patients (20.9%); 364 patients (53.2%) were diagnosed to have Helicobacter pylori infection. CONCLUSION The high number of significant endoscopic and histopathological findings in our study supports the routine use of preoperative EGD in all bariatric surgery patients. However, omitting EGD before Roux-en-Y gastric bypass (RYGB) in asymptomatic patients is still reasonable as the most frequently found significant findings, esophagitis, and hiatus hernia, are less likely to impact the operative plans in RYGB. Similarly, active surveillance and treatment of H. pylori infections in obese patients are important but it is not clear whether H. pylori eradication should be done before bariatric surgery.
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Sawathanon S, Promchan D, Thongwong M, Wangkulangkul P, Cheewatanakornkul S, Keeratichananont S, Yolsuriyanwong K. Impact of preoperative esophagogastroduodenoscopy in patients undergoing bariatric surgery and development of a model to predict clinically significant abnormal endoscopic findings. Surg Endosc 2023; 37:2202-2208. [PMID: 35864356 PMCID: PMC9302948 DOI: 10.1007/s00464-022-09391-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preoperative esophagogastroduodenoscopy (EGD) in patients undergoing bariatric surgery can help surgeons detect abnormalities in the upper gastrointestinal (UGI) tract that may require a change in surgical plan. However, the need for EGD before bariatric surgery is controversial. OBJECTIVES We aimed to determine the prevalence of UGI abnormalities and evaluate the predictive factors of abnormal findings that require a change in surgical plan or cause a delay in surgical treatment in patients undergoing bariatric surgery and develop a prediction model. METHODS The medical records from January 2012 to July 2020 were retrospectively reviewed in patients who underwent EGD before bariatric surgery. The EGD findings were classified into four groups based on their effects on management. Group 1 had normal findings. Group 2 had abnormal findings that did not require a change in surgical management. Group 3 had abnormal findings that required a change in the surgical plan or caused a delay in surgical treatment. Group 4 had contraindications to surgery. Predictive factors for Groups 3 and 4 were analyzed using univariate and multivariate analyses. A model visualized as a nomogram was developed based on significant factors. Discrimination and calibration were evaluated. RESULTS A total of 461 patient records (63.8% female) were reviewed. The mean age was 35.1 ± 11.2 years and the mean BMI was 47.7 ± 8.7 kg/m2. The prevalence of endoscopic findings in Groups 1, 2, 3, and 4 were 42.5%, 35.6%, 21.9%, and 0%, respectively. The most common abnormal findings were non-erosive gastritis (31.2%) followed by Helicobacter pylori infection (18.7%) and hiatal hernia (10.2%). Male sex and NSAID use were significantly associated with detection of lesions in Group 3 either on univariate or multivariate analysis, while type 2 diabetes mellitus (T2DM) was a significant protective factor on multivariate analysis. On subgroup analysis in patients ≥ 40 years old, multivariate analysis revealed age, BMI, and NSAID use were significantly associated with the detection of lesions in Group 3, while T2DM was still a significant protective factor. A nomogram to predict lesions in Group 3 for this subgroup was developed and showed good discrimination (C-statistics 0.737, 95% CI 0.721‒0.752). CONCLUSION A high prevalence of abnormal endoscopic findings was observed in Thai patients who are undergoing bariatric surgery. Preoperative EGD screening is helpful in detecting UGI abnormalities that require a change in the surgical decision plan. The new nomogram may help rational utilization of EGD prior to bariatric surgery.
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Affiliation(s)
- Surawitch Sawathanon
- Songklanagarind Excellence Center for Obesity and Metabolic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Darawan Promchan
- Nursing Service Division, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Meena Thongwong
- Nursing Service Division, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Piyanun Wangkulangkul
- Songklanagarind Excellence Center for Obesity and Metabolic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Siripong Cheewatanakornkul
- Songklanagarind Excellence Center for Obesity and Metabolic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Suriya Keeratichananont
- Nanthana-Kriengkrai Chotiwatanaphan Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Kamthorn Yolsuriyanwong
- Songklanagarind Excellence Center for Obesity and Metabolic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
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The utility of endoscopy prior to bariatric surgery: an 11-year retrospective analysis of 885 patients. Surg Endosc 2022; 37:3127-3135. [PMID: 35941309 DOI: 10.1007/s00464-022-09485-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/13/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Our aim was to evaluate the diagnostic yield of routine preoperative esophagogastroduodenoscopy (p-EGD) in patients undergoing bariatric surgery. Many medical problems that are common in patients with obesity, including gastroesophageal reflux disease (GERD) and hiatal hernias, have important implications for patients undergoing bariatric surgery. While p-EGD is considered standard of care prior to antireflux surgery, the role of p-EGD in bariatric surgery patients remains controversial. METHODS AND PROCEDURES We performed a retrospective chart review of 885 patients who underwent primary bariatric surgery at a university hospital-based bariatric surgery program between March 2011 and February 2022. Clinical history, demographics, and preoperative EGD reports were reviewed for abnormal findings. RESULTS Of the 885 patients evaluated in this study, one or more abnormal EGD findings were observed in 83.2% of patients. More than half of our patients (54.7%) presented with history of heartburn, reflux, or GERD. EGD findings demonstrated a hernia in 43.1% of patients [(Type I: 40.6%; Type II: 0.5%; Type III: 2.1%)]. 68.0% of patients were biopsied. Among patients who were biopsied, other findings included gastritis (32.4%), esophagitis (8.0%), eosinophilic esophagitis (4.7%), or duodenitis (2.7%). We found ulcers in 6.7% of patients. Pathology was consistent with H. pylori in 9.8% of biopsies taken and consistent with BE in 2.7%. Following routine p-EGD, 11.2% of patients were placed on PPI and 8.3% were recommended to stop NSAIDs. CONCLUSION Gastroesophageal reflux disease and associated pathology are common in the bariatric population. Preoperative EGD in patients undergoing bariatric surgery frequently identifies clinically significant UGI pathology. This may have important implications for medical and surgical management. Given the rate of abnormal preoperative endoscopic findings in obese patients, the work-up for bariatric surgery should align with the current recommendations for foregut surgery.
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Predictive Factors for Developing GERD After Sleeve Gastrectomy: Is Preoperative Endoscopy Necessary? J Gastrointest Surg 2022; 26:1015-1020. [PMID: 34997468 DOI: 10.1007/s11605-021-05207-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/16/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is the most common bariatric procedure performed in the USA. There is a concern for new gastroesophageal reflux disease (GERD) and Barrett's esophagus after SG. Endoscopic screening before bariatric surgery is controversial. We sought to identify preoperative endoscopic factors that may predict the development of GERD after SG. METHODS We prospectively evaluated 217 patients undergoing primary robotic-assisted SG. All patients underwent endoscopy before SG and for-cause postoperatively. Patients were followed for the development of GERD, diagnosed by either biopsy-proven reflux esophagitis or a positive esophageal pH test. Patients were separated into 2 groups: Those who developed GERD after surgery (GERD group) and those who did not (No GERD group). Patients with a positive preoperative pH test, LA Grade B or greater esophagitis, or hiatal hernia > 5 cm on preoperative endoscopy were counseled to undergo gastric bypass and excluded. RESULTS There were more males in the No GERD group (25.6% vs. 8.1%; p = 0.02). More patients had preoperative heartburn symptoms in the GERD group (40.5% vs. 23.9%; p = 0.04). Endoscopically identified esophagitis was more common in the GERD group (29.7% vs. 13.3%; p = 0.01), as was biopsy-proven esophagitis (24.3% vs. 11.1%; p = 0.03). There was no significant difference in the incidence or size of hiatal hernia or in the rate of H. pylori infection between the groups. On multivariate analysis, the strongest predictors of GERD after SG were endoscopically identified esophagitis (odds ratio [OR] 2.79; 95% confidence interval [CI]1.17-6.69; p = 0.02) and biopsy-proven esophagitis (OR 2.80; 95% CI 1.06-7.37; p = 0.04). Male patients were less likely to develop GERD after SG (OR 0.23; 95% CI 0.06-0.85; p = 0.03). CONCLUSION Our findings strengthen the rationale for routine preoperative endoscopy and highlight critical clinical and endoscopic criteria that should prompt consideration of alternatives to SG for weight loss.
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Kanat BH, Doğan S. Is gastroscopy necessary before bariatric surgery? World J Gastrointest Endosc 2022; 14:29-34. [PMID: 35116097 PMCID: PMC8788171 DOI: 10.4253/wjge.v14.i1.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/26/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023] Open
Abstract
Obesity is the abnormal accumulation of fat or adipose tissue in the body. It has become a serious health problem in the world in the last 50 years and is considered a pandemic. Body mass index is a widely used classification. Thus, obese individuals can be easily classified and standardized. Obesity is the second cause of preventable deaths after smoking. Obesity significantly increases mortality and morbidity. We thought of preparing a publication about routine procedures for the preoperative evaluation of obesity. The question that we asked as bariatric and metabolic surgeons but which was not exactly answered in the literature was "Is esophagogastroduodenoscopy (EGD) necessary before bariatric surgery?" We found different answers in our literature review. The European Association of Endoscopic Surgery guidelines recommend EGD for all bariatric procedures. They strongly recommend it for Roux-en-Y gastric bypass (RYGB). As a result of a recent study by the members of the British Obesity & Metabolic Surgery Society, preoperative EGD is routinely recommended for patients undergoing sleeve gastrectomy, even if they are asymptomatic, but not recommended for RYGB. It is recommended for symptomatic patients scheduled for RYGB. According to the International Sleeve Gastrectomy Expert Panel Consensus Statement, preoperative EGD is definitely recommended for patients scheduled for sleeve gastrectomy, but its routine use for RYGB is controversial. However, a different view is that the American Society for Gastrointestinal Endoscopy recommends endoscopy only for symptomatic patients scheduled for bariatric surgery. In the literature, the primary goal of EGD recommended for sleeve gastrectomy has been interpreted as determining esophagitis caused by gastroesophageal reflux. In the light of the literature, it is stated that this procedure is not necessary in America, while it is routinely recommended in the European continent. Considering medicolegal cases that may occur in the future, we are in favor of performing EGD before bariatric surgery. In conclusion, EGD before bariatric surgery is insurance for both patients and physicians. There is a need for larger and prospective studies to reach more precise conclusions on the subject.
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Affiliation(s)
- Burhan Hakan Kanat
- Department of General Surgery, Malatya Turgut Özal University, School of Medicine, Malatya 44100, Turkey
| | - Serhat Doğan
- Department of General Surgery, Malatya Turgut Özal University, School of Medicine, Malatya 44100, Turkey
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Controversies in the Preoperative Workup and Management for Patients Undergoing Bariatric Surgery: A Review of the Literature. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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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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ASMBS position statement on the rationale for performance of upper gastrointestinal endoscopy before and after metabolic and bariatric surgery. Surg Obes Relat Dis 2021; 17:837-847. [PMID: 33875361 DOI: 10.1016/j.soard.2021.03.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/13/2021] [Indexed: 12/18/2022]
Abstract
The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to inquiries made to the Society by patients, physicians, society members, hospitals, health insurance payors, the media, and others regarding the need and possible strategies for screening endoscopic examination before metabolic and bariatric surgery (MBS), as well as the rationale, indications, and strategies for postoperative surveillance for mucosal abnormalities, including gastroesophageal reflux disease and associated esophageal mucosal injuries (erosive esophagitis and Barrett's esophagus) that may develop in the long term after MBS, specifically for patients undergoing sleeve gastrectomy or Roux-en-Y gastric bypass. The general principles described here may also apply to procedures such as biliopancreatic diversion (BPD) and BPD with duodenal switch (DS); however, the paucity of procedure-specific literature for BPD and DS limits the value of this statement to those procedures. In addition, children with obesity undergoing MBS may have unique considerations and are not specifically addressed in this position statement. This recommendation is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement is not intended to be and should not be construed as stating or establishing a local, regional, or national standard of care. The statement will be revised in the future as additional evidence becomes available.
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Qumseya BJ. Quality assessment for systematic reviews and meta-analyses of cohort studies. Gastrointest Endosc 2021; 93:486-494.e1. [PMID: 33068610 DOI: 10.1016/j.gie.2020.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS There is a growing need for valid, efficient, and easy scoring scales to rate the quality of cohort studies. We aimed to develop and validate a quality assessment score to be used for cohort studies. METHODS We followed a rigorous process to establish content, face, and construct validity. Most questions were scored at 0 or 1. Inter-rater reliability and test-retest reliability were assessed using the Spearman correlation coefficient (rs) and Cohen's κ statistic. Internal consistency was measured using the Kuder-Richardson formula 20 (KR20). RESULTS The final tool consists of 9 questions with a maximum score of 10. The inter-rater reliability was high with the Spearman correlation coefficient (rs = .66). Agreement for inclusion was 90%. Test-retest reliability was high. For rater 1, rs = .91, κ = .38 for scores, and κ = 1 for inclusion. For rater 2, r = .94, 80% agreement for scores, and 100% agreement for inclusion. Internal consistency was reasonable based on 2 studies: KR20 = .21 and KR20 = .65. The novel scale rated highest in efficiency, understandably, ease of use, and ease of interpretation when compared with 3 other scales. CONCLUSIONS This novel scale has favorable performance characteristics, is efficient to conduct, and is easy to interpret and will be very helpful for physicians and researchers conducting systematic reviews and meta-analyses.
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Affiliation(s)
- Bashar J Qumseya
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA.
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LaMasters T. Comment on: Esophageal adenocarcinoma after sleeve gastrectomy: actual or potential threat? Italian series and literature review. Surg Obes Relat Dis 2021; 17:854-856. [PMID: 33676873 DOI: 10.1016/j.soard.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Teresa LaMasters
- UnityPoint Clinic Weight Loss Specialists, West Des Moines, Iowa
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Fisher OM, Chan DL, Talbot ML, Ramos A, Bashir A, Herrera MF, Himpens J, Shikora S, Higa KD, Kow L, Brown WA. Barrett's Oesophagus and Bariatric/Metabolic Surgery-IFSO 2020 Position Statement. Obes Surg 2021; 31:915-934. [PMID: 33460005 DOI: 10.1007/s11695-020-05143-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/07/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022]
Abstract
The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has been playing an integral role in educating both the metabolic surgical and the medical community at large about the importance of surgical and/or endoscopic interventions in treating adiposity-based chronic diseases. The occurrence of chronic conditions following bariatric/metabolic surgery (BMS), such as gastro-oesophageal reflux disease (GERD) and columnar (intestinal) epithelial metaplasia of the distal oesophagus (also known as Barrett's oesophagus (BE)), has long been discussed in the metabolic surgical and medical community. Equally, the risk of neoplastic progression of Barrett's oesophagus to oesophageal adenocarcinoma (EAC) and the resulting requirement for surgery are the source of some concern for many involved in the care of these patients, as the surgical alteration of the gastrointestinal tract may lead to impaired reconstructive options. As such, there is a requirement for guidance of the community.The IFSO commissioned a task force to elucidate three aspects of the presenting problem: First, to determine what the estimated incidence of Barrett's oesophagus is in patients presenting for BMS; second, to determine the frequency at which Barrett's oesophagus may develop following BMS (with a particular focus on the laparoscopic sleeve gastrectomy (LSG)); and third, to determine if regression of Barrett's oesophagus may occur following BMS given the close relationship of obesity and the development of BE/EAC. Based on these findings, a position statement regarding the management of this pathology in the context of BMS was developed. The following position statement is issued by the IFSO Barrett's Oesophagus task force andapproved 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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Affiliation(s)
- Oliver M Fisher
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Daniel L Chan
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Michael L Talbot
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Almino Ramos
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Ahmad Bashir
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Miguel F Herrera
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Jacques Himpens
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Scott Shikora
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Kelvin D Higa
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Lilian Kow
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Wendy A Brown
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy. .,Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia.
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15
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Shetty A, Nasta A, Gupte A, Goel R. The role of upper gastrointestinal endoscopy in bariatric procedure selection: A case series and literature review. J Minim Access Surg 2021; 17:81-84. [PMID: 33353892 PMCID: PMC7945648 DOI: 10.4103/jmas.jmas_139_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Bariatric surgery leads to a significant improvement in obesity and associated comorbidities. Safe surgical outcomes are especially desirable in bariatric, as most patients perceive it as an aesthetic surgery, while an intestinal/gastric surgery may be associated with morbidity. A detailed pre-operative evaluation is required to avoid surgical surprises and post-operative complications. Besides other routine investigations, pre-surgery upper gastrointestinal (GI) endoscopy has always been a topic of debate. Some surgeons perform it routinely before the surgery, whereas others perform it selectively. It is mostly accepted that pre-operative diagnosis of gastro-oesophageal reflux disease could change the plan of surgery in favour of Roux-en-Y gastric bypass although similar consensus does not exist in favour of Sleeve gastrectomy if a gastric/duodenal pathology is detected pre-operatively in a planned roux-en-y gastric bypass patient. Aim: Through this case series, we want to highlight the role of routine pre-operative upper GI endoscopy in selecting the bariatric surgery. Cases: We present four cases, from amongst many others, where endoscopy changed the course of bariatric surgery. Conclusion: Upper GI endoscopy should be performed before bariatric surgery, even in asymptomatic patients, to avoid post-operative surprise/complication.
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Affiliation(s)
- Aashik Shetty
- Centre for Metabolic Surgery, Wockhardt Hospital, Mumbai, Maharashtra, India
| | - Amrit Nasta
- Centre for Metabolic Surgery, Wockhardt Hospital, Mumbai, Maharashtra, India
| | - Amit Gupte
- Department of Gastroenterology, Wockhardt Hospital, Mumbai, Maharashtra, India
| | - Ramen Goel
- Centre for Metabolic Surgery, Wockhardt Hospital, Mumbai, Maharashtra, India
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16
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El Ansari W, El-Menyar A, Sathian B, Al-Thani H, Al-Kuwari M, Al-Ansari A. Is Routine Preoperative Esophagogastroduodenoscopy Prior to Bariatric Surgery Mandatory? Systematic Review and Meta-analysis of 10,685 Patients. Obes Surg 2020; 30:3073-3083. [PMID: 32468339 PMCID: PMC7305097 DOI: 10.1007/s11695-020-04672-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This systematic review and meta-analysis searched, retrieved and synthesized the evidence as to whether preoperative esophagogastroduodenoscopy (p-EGD) should be routine before bariatric surgery (BS). METHODS Databases searched for retrospective, prospective, and randomized (RCT) or quasi-RCT studies (01 January 2000-30 April 2019) of outcomes of routine p-EGD before BS. STROBE checklist assessed the quality of the studies. P-EGD findings were categorized: Group 0 (no abnormal findings); Group 1 (abnormal findings that do not necessitate changing the surgical approach or postponing surgery); Group 2 (abnormal findings that change the surgical approach or postpone surgery); and Group 3 (findings that signify absolute contraindications to surgery). We assessed data heterogeneity and publication bias. Random effect model was used. RESULTS Twenty-five eligible studies were included (10,685 patients). Studies were heterogeneous, and there was publication bias. Group 0 comprised 5424 patients (56%, 95% CI: 45-67%); Group 1, 2064 patients (26%, 95% CI: 23-50%); Group 2, 1351 patients (16%, 95% CI: 11-21%); and Group 3 included 31 patients (0.4%, 95% CI: 0-1%). CONCLUSION For 82% of patients, routine p-EGD did not change surgical plan/ postpone surgery. For 16% of patients, p-EGD findings necessitated changing the surgical approach/ postponing surgery, but the proportion of postponements due to medical treatment of H Pylori as opposed to "necessary" substantial change in surgical approach is unclear. For 0.4% patients, p-EGD findings signified absolute contraindication to surgery. These findings invite a revisit to whether p-EGD should be routine before BS, and whether it is judicious to expose many obese patients to an invasive procedure that has potential risk and insufficient evidence of effectiveness. Further justification is required.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Schools of Health and Education, University of Skovde, Skövde, Sweden
| | - Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Brijesh Sathian
- Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery Section, Hamad Medical Corporation, Doha, Qatar
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17
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Adil MT, Al-Taan O, Rashid F, Munasinghe A, Jain V, Whitelaw D, Jambulingam P, Mahawar K. A Systematic Review and Meta-Analysis of the Effect of Roux-en-Y Gastric Bypass on Barrett's Esophagus. Obes Surg 2020; 29:3712-3721. [PMID: 31309524 DOI: 10.1007/s11695-019-04083-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Obesity is associated with a twofold risk of gastroesophageal reflux disease (GERD) and thrice the risk of Barrett's esophagus (BE). Roux-en-Y gastric bypass (RYGB) leads to weight loss and improvement of GERD in population with obesity, but its effect on BE is less clear. METHODS Bibliographic databases were searched systematically for relevant articles till January 31, 2019. Studies evaluating the effect of RYGB on BE with preoperative and postoperative endoscopy and biopsy were included. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool. Meta-analysis was conducted using Mantel-Haenszel, random effects model and presented as risk difference (RD) or odds ratio (OR) with 95% confidence intervals. RESULTS Eight studies with 10,779 patients undergoing RYGB reported on 117 patients with BE with follow-up of > 1 year. Significant regression of BE after RYGB was observed (RD - 0.56.95% c.i. - 0.69 to - 0.43; P < 0.001). Subgroup analysis showed regression of both short-segment BE [ssBE] (RD - 0.51.95% c.i. - 0.68 to - 0.33; P < 0.001) and long-segment BE [lsBE] (RD - 0.46.95% c.i. - 0.71 to - 0.21; P < 0.001). RYGB also caused improvement in GERD in patients of BE (RD - 0.93, 95% c.i. - 1.04 to - 0.81; P < 0.001). RYGB was strongly associated with regression of BE compared with progression (OR 31.2.95% c.i. 11.37 to 85.63; P < 0.001). CONCLUSIONS RYGB leads to significant improvement of BE at > 1 year after surgery in terms of regression and resolution of the associated GERD. Both ssBE and lsBE improve after RYGB significantly.
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Affiliation(s)
- Md Tanveer Adil
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, United Kingdom.
| | - Omer Al-Taan
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, United Kingdom
| | - Farhan Rashid
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, United Kingdom
| | - Aruna Munasinghe
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, United Kingdom
| | - Vigyan Jain
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, United Kingdom
| | - Douglas Whitelaw
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, United Kingdom
| | - Periyathambi Jambulingam
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, United Kingdom
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP, United Kingdom
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18
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High Cost for Low Yield: A Systematic Review and Meta-Analysis to Assess Cost of Routine Preoperative Esophagogastroduodenoscopy Before Bariatric Surgery. J Clin Gastroenterol 2020; 54:398-404. [PMID: 32168132 DOI: 10.1097/mcg.0000000000001334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Routine esophagogastroduodenoscopy (EGD) is an area of continued controversy in the preoperative evaluation for bariatric surgery; more information is needed regarding its impact on surgical management and associated costs. This systematic review and meta-analysis reports rates of abnormalities detected on preoperative EGD that changed operative management or delayed bariatric surgery. Sensitivity analysis examined the impact of controversial findings of hiatal hernia, Helicobacter pylori, gastritis, peptic ulcer disease. Data were used to calculate the cost per surgical alteration made due to abnormalities detected by routine EGD, compactly termed "cost-of-routine-EGD." Thirty-one retrospective observational studies were included. Meta-analysis found 3.9% of EGDs resulted in a change in operative management; this proportion decreased to 0.3% after sensitivity analysis, as detection of hiatal hernia comprised 85.7% of findings that changed operative management. Half of the 7.5% of cases that resulted in surgical delay involved endoscopic detection of H. pylori. Gastric pathology was detected in a significantly greater proportion of symptomatic patients (65.0%) than in asymptomatic patients (34.1%; P<0.001). Cost-of-routine-EGD to identify an abnormality that changed operative management was $601,060, after excluding controversial findings. The cost-of-routine-EGD to identify any abnormality that led to a change in type of bariatric operation was $281,230 and $766,352 when controversial findings were included versus excluded, respectively. Cost-of-routine-EGD to identify a malignancy was $2,554,506. Cost-of-routine-EGD is high relative to the low proportion of abnormalities that alter bariatric surgery. Our results highlight the need to develop alternative strategies to preoperative screening, in order to improve access and decrease cost associated with bariatric surgery.
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19
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Upper Gastrointestinal Endoscopy in Adolescents With Severe Obesity Before Vertical Sleeve Gastrectomy. J Pediatr Gastroenterol Nutr 2019; 69:287-291. [PMID: 31436669 DOI: 10.1097/mpg.0000000000002371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Esophagogastroduodenoscopy (EGD) is often performed to evaluate for mucosal and anatomical abnormalities before vertical sleeve gastrectomy (SG). Little is known, however, about how prebariatric EGD in adolescents influences clinical management or outcome. Our aim was to assess if an abnormal prebariatric EGD resulted in interventions or modification of bariatric surgery. METHODS We performed a retrospective cohort study of adolescents undergoing evaluation for bariatric surgery. We obtained demographic and anthropometric data in addition to EGD findings, biopsy pathology, gastrointestinal symptoms, and surgical outcomes. An EGD was considered abnormal if either abnormal gross findings or abnormal pathology was reported. Patients were followed until a 6-week postop visit. RESULTS Of 134 patients presenting for evaluation, 94 (70%) underwent preoperative EGD. Fifty-one (54%) had a normal EGD and 43 (46%) had EGD abnormalities including 7 with an anatomical abnormality and 36 with mild mucosal abnormalities. Among patients with EGD abnormalities, 22% received medical intervention including proton pump inhibitor (PPI) administration (n = 10) and Helicobacter pylori eradication (n = 11). GI symptoms were the only predictor of EGD abnormalities (odds ratio [OR] 4.9: 95% confidence interval [CI] 1.6-15.0; P < 0.001). No factors predicted likelihood of a post-EGD intervention. An abnormal EGD did not correlate with any postoperative complications. CONCLUSIONS In this cohort of adolescents undergoing evaluation for SG, 46% had an abnormal EGD, of which 22% received a medical intervention. Symptoms were the only predictor of EGD abnormalities. Abnormal EGD findings were not associated with modification of the surgery or any adverse outcome.
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20
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Mazahreh TS, Aleshawi AJ, Al-Zoubi NA, Allouh MZ, Jadallah KA, Elayyan R, Novotny NM. Preoperative esophagogastroduodenoscopy in patients without reflux symptoms undergoing laparoscopic sleeve gastrectomy: utility or futility? Clin Exp Gastroenterol 2019; 12:295-301. [PMID: 31456645 PMCID: PMC6620317 DOI: 10.2147/ceg.s216188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/12/2019] [Indexed: 12/12/2022] Open
Abstract
Aim To evaluate the value of esophagogastroduodenoscopy (EGD) as a preoperative investigation in individuals without symptoms of Gastro-Esophageal Reflux Disease (GERD) who will undergo laparoscopic sleeve gastrectomy (LSG). Materials and methods After Institutional Review Board approval was obtained, patients scheduled for LSG were prospectively enrolled in the study between January 2016 and March 2018. Patients with symptoms of GERD were excluded from the study. Participants were randomly allocated to two groups: individuals who underwent EGD before the surgery as a usual routine investigation (Group A), and individuals who were scheduled without preoperative EGD (Group B). Patient demographics, endoscopic findings, endoscopic biopsy results, and histopathological findings of the resected parts of the stomach after LSG were analyzed and recorded. Additionally, operative characteristics and outcomes, and follow up findings were recorded and analyzed with appropriate statistical methods. Results A total of 219 individuals without symptoms of GERD underwent LSG were enrolled. Group A included 111 individuals (25 males and 86 females). Group B comprised 108 individuals (20 males and 88 females). The mean age and mean Body Mass Index (BMI) were similar in both groups. From Group A, 86 out of 111 individuals (77.5%) had no pathology identified on EGD, while 21 individuals (18.9%) were found to have areas of gastric erythema and biopsies showed active gastritis. All LSG operations were performed without any major complication. After one year, all individuals were assessed for the presence of symptomatic GERD and no significant difference was found between the two groups. Conclusion Preoperative EGD may not be mandatory for asymptomatic GERD individuals undergoing LSG as post-operative complications and early follow up for GERD symptoms are not significantly different. Further prospective studies with longer follow up are needed to evaluate the role of EGD in individuals undergoing LSG.
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Affiliation(s)
- Tagleb S Mazahreh
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Abdelwahab J Aleshawi
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Nabil A Al-Zoubi
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Mohammed Z Allouh
- Department of Anatomy, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan.,Department of Anatomy, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain 17666, UAE
| | - Khaled A Jadallah
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Rasheed Elayyan
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Nathan M Novotny
- Department of Pediatric Surgery, Beaumont Children's, Oakland University William Beaumont School of Medicine, Michigan 48073, USA
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21
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AlEid A, Al Balkhi A, Hummedi A, Alshaya A, Abukhater M, Al Mtawa A, Al Khathlan A, Qutub A, Al Sayari K, Ahmad S, Azhar T, Al Otaibi N, Al Ghamdi A, Al Lehibi A. The utility of esophagogastroduodenoscopy and Helicobacter pylori screening in the preoperative assessment of patients undergoing bariatric surgery: A cross-sectional, single-center study in Saudi Arabia. Saudi J Gastroenterol 2019; 26:32-38. [PMID: 31898643 PMCID: PMC7045771 DOI: 10.4103/sjg.sjg_165_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIM Esophagogastroduodenoscopy (EGD) and Helicobacter pylori screening are routine parts of the preoperative assessment of patients undergoing bariatric surgery at many centers around the world. The reason for this step is to identify abnormalities that may change the surgical approach. In this study, we aim to evaluate the extent to which endoscopic findings and H. pylori testing affect the plan of care in bariatric patients. PATIENTS AND METHODS We retrospectively reviewed the investigational processes of 356 patients planned for bariatric surgery (2014-2016) at our center. Patients were categorized into two main groups (4 subgroups) from endoscopic findings. One group included patients with normal EGD and patients who had abnormal findings that did not change the surgical approach, whereas the other included patients who had findings that changed or canceled the surgical plan. A logistic regression analysis was used to evaluate how strongly can factors such as patient demographics, BMI, comorbidities, symptomatology, and H. pylori status predict the risk of having plan-changing endoscopic abnormalities. RESULTS The ages ranged between 15 and 66 years with a mean ± SD of 37 ± 11 years, and 56% were females. The majority of patients (75%; 95% CI: 73 - 82%) had either no findings (41%) or had abnormalities that did not change the surgical approach (34%). Only 25% (95% CI: 21-29%) were found to have pathologies that altered the surgical approach, and 0.6% of them had findings that were considered contraindications for surgery. In spite the relatively high prevalence of H. pylori in our cohort (41%; 95% CI 36-46%), the proportion of patients who had plan-changing abnormalities did not differ markedly from other studies. Gastroesophageal reflux disease (GERD) and obstructive sleep apnea symptoms were the only significant predictors of EGD findings (P = 0.009). CONCLUSIONS GERD and sleep apnea symptoms can be strong predictors of EGD abnormalities. However, this evidence is still not enough to safely recommend changing the current practice. Therefore, until a sensitive clinical prediction score is derived and validated according to the symptoms, we suggest that EGD should continue as the standard of care in all patients undergoing bariatric surgery.
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Affiliation(s)
- Ahmad AlEid
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia,Address for correspondence: Dr. Ahmad AlEid, Department of Gastroenterology and Hepatology, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia. E-mail:
| | - Areej Al Balkhi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Hummedi
- Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Anfal Alshaya
- Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Muhammad Abukhater
- Department of Surgical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Mtawa
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Khathlan
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Adel Qutub
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Al Sayari
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shameem Ahmad
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tauseef Azhar
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nawaf Al Otaibi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed Al Ghamdi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abed Al Lehibi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
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Kassir R, Kassir R, Deparseval B, Bekkar S, Serayssol C, Favre O, Garnier PP. Routine surveillance endoscopy before and after sleeve gastrectomy? World J Gastrointest Endosc 2019; 11:1-4. [PMID: 30705727 PMCID: PMC6354110 DOI: 10.4253/wjge.v11.i1.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/22/2018] [Accepted: 12/30/2018] [Indexed: 02/06/2023] Open
Abstract
There is no consensus when it comes to the necessity of an oeso-gastroduodenal fibroscopy (OGDF) before and after bariatric surgery. Many reports expressed the preoccupations about a gastroesophagal reflux disease (an acute risk of Barrett’s esophagus) and its consequences after a sleeve gastrectomy (SG) and the risk of leaving a premalignant lesion in an excluded stomach after a Roux-en-Y gastric bypass. The International Federation for the Surgery of Obesity and Metabolic Disorders recommends a surveillance endoscopy, routinely after a SG. After review of the literature, we set out the arguments in favor of performing a systematic preoperative and post-operative OGDF.
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Affiliation(s)
- Radwan Kassir
- Department of Bariatric Surgery, CHU Félix Guyon, La Réunion, Saint Denis 97400, France
| | - Rani Kassir
- Department of Bariatric Surgery, CHU Félix Guyon, La Réunion, Saint Denis 97400, France
| | - Bénédicte Deparseval
- Department of Bariatric Surgery, CHU Félix Guyon, La Réunion, Saint Denis 97400, France
| | - Sarah Bekkar
- Department of Bariatric Surgery, CHU Félix Guyon, La Réunion, Saint Denis 97400, France
| | - Chloé Serayssol
- Department of Bariatric Surgery, CHU Félix Guyon, La Réunion, Saint Denis 97400, France
| | - Olivier Favre
- Department of Gastroenterology, CHU Félix Guyon, La Réunion, Saint Denis 97400, France
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D’Silva M, Bhasker AG, Kantharia NS, Lakdawala M. High-Percentage Pathological Findings in Obese Patients Suggest that Esophago-gastro-duodenoscopy Should Be Made Mandatory Prior to Bariatric Surgery. Obes Surg 2018; 28:2753-2759. [DOI: 10.1007/s11695-018-3230-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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24
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Bencsath KP. Comment on: is preoperative gastroscopy necessary prior to sleeve gastrectomy and Roux-en-Y gastric bypass? Surg Obes Relat Dis 2018; 14:762-763. [PMID: 29571636 DOI: 10.1016/j.soard.2018.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 02/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Kalman P Bencsath
- Department of General Surgery, Cleveland Clinic, Mayfield Heights, Ohio
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25
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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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26
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Mohammed R, Fei P, Phu J, Asai M, Antanavicius G. Efficiency of preoperative esophagogastroduodenoscopy in identifying operable hiatal hernia for bariatric surgery patients. Surg Obes Relat Dis 2016; 13:287-290. [PMID: 27639984 DOI: 10.1016/j.soard.2016.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/23/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gastroesophageal reflux (GERD) is a symptom frequently found in obese patients, and often is related to the presence of a hiatal hernia (HH). Surgeons may evaluate for the presence of HH on esophagogastroduodenoscopy (EGD). However, preoperative endoscopic presence or absence of a significant HH does not always correlate with intraoperative findings. OBJECTIVE To compare the rate of detection of repairable HH between clinical, endoscopic, and intraoperative methods SETTING: Independent, university-affiliated teaching hospital METHODS: A retrospective chart review of all consecutive patients who had undergone a primary bariatric procedure sleeve gastrectomy, gastric bypass, or biliopancreatic diversion/duodenal switch with routine preoperative EGD in a single institution from 2009-2013 was performed. Data points included the diagnosis of GERD/heartburn/proton pump inhibitor or histamine antagonist from history, the diagnosis of HH from preoperative EGD, and the diagnosis of HH intraoperatively that merited repair. RESULTS 1570 consecutive patients were included in the study. Eight hundred fifty-seven (55%) had diagnosis of GERD or heartburn, and 713 (45%) were asymptomatic (negative for GERD or heartburn). Hiatal hernia repair was performed in 153 (18%) patients with the diagnosis of GERD or heartburn and in 107 (15%) patients without the diagnosis of GERD and or heartburn. In all, 434 (28%) out of 1570 patients had a finding of HH on EGD; 204 (47%) were repaired. On endoscopy, 326 (75%) were defined as small, 87 (20%) as moderate, and 21(5%) as large HH. Of these, repairs were done on 128 (39%), 60 (70%), and 16 (76%). The sensitivity of detecting repairable HH by clinical indicators such as GERD or heartburn was 55% (P = .123) and sensitivity of EGD findings was 78% (P = .000). Specificity was 46% and 82%, respectively. CONCLUSION Small HH are over-diagnosed with EGD, as most do not require repair. However, moderate and large HH are accurately detected.
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Affiliation(s)
| | | | - John Phu
- 1200 Old York Road, Abington, Pennsylvania
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Mihmanli M, Yazici P, Isil G, Tanik C. Should We Perform Preoperative Endoscopy Routinely in Obese Patients Undergoing Bariatric Surgery? Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2015.0050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Mehmet Mihmanli
- General Surgery Clinic, Sisli Hamidiye Etfal Training and Research Hospital, Sisli, Istanbul, Turkey
| | - Pinar Yazici
- General Surgery Clinic, Sisli Hamidiye Etfal Training and Research Hospital, Sisli, Istanbul, Turkey
| | - Gurhan Isil
- General Surgery Clinic, Sisli Hamidiye Etfal Training and Research Hospital, Sisli, Istanbul, Turkey
| | - Canan Tanik
- Pathology Clinic, Sisli Hamidiye Etfal Training and Research Hospital, Sisli, Istanbul, Turkey
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Bennett S, Gostimir M, Shorr R, Mallick R, Mamazza J, Neville A. The role of routine preoperative upper endoscopy in bariatric surgery: a systematic review and meta-analysis. Surg Obes Relat Dis 2016; 12:1116-1125. [PMID: 27320221 DOI: 10.1016/j.soard.2016.04.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/17/2016] [Accepted: 04/11/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND The necessity of routine preoperative esophagogastroduodenoscopy (EGD) before bariatric surgery is controversial. European guidelines recommend routine EGD while North American guidelines recommend a selective approach. OBJECTIVE Perform a systematic review and meta-analysis to determine the proportion and scope of clinical findings discovered at preoperative EGD. SETTING Academic hospital, Canada. METHODS A search of MEDLINE, Embase, and Cochrane databases included MeSH terms "bariatric surgery," "endoscopy," and "preoperative." Inclusion criteria were any case series, cohort study, or clinical trial describing results of preoperative EGD for any bariatric surgery. Exclusion criteria were studies with<10 patients, patients<18 years of age, or revisional operations. Changes in surgical and medical management and proportions of pathologic findings were extracted and combined in a meta-analysis using the random effects model. RESULTS Initial search identified 532 citations. Forty-eight were included after full text review. Included studies comprised 12,261 patients with a mean (SD) age of 40.5 (1.3) years and body mass index of 46.3 (1.5) kg/m(2). The majority of patients (77.1%) were female. The proportion of EGDs resulting in a change in surgical management was 7.8%. After removing benign findings with controversial impact on management (hiatal hernia, gastritis, peptic ulcer), this was found to be .4%. Changes in medical management were seen in 27.5%, but after eliminating Helicobacter pylori eradication, this was found to be 2.5%. CONCLUSION Preoperative EGD in average-risk, asymptomatic bariatric surgery patients should be considered optional, as the proportion of EGDs that resulted in important changes in management was low.
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Affiliation(s)
- Sean Bennett
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Risa Shorr
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph Mamazza
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Amy Neville
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
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Gomberawalla A, Lutfi R. Benefits of intraoperative endoscopy: case report and review of 300 sleeves gastrectomies. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2015; 9:13. [PMID: 26692038 PMCID: PMC4684936 DOI: 10.1186/s13022-015-0023-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 11/30/2015] [Indexed: 11/12/2022]
Abstract
Background The laparoscopic sleeve gastrectomy (LSG) is the fastest rising bariatric procedure being performed in the United States.
Some surgeons advocate for an intra-operative endoscopy for their leak test, while others utilize air via a form of an oral gastric tube. We present a case demonstrating the benefits of endoscopy intra-operatively as well as discuss our experience of 200 consecutive sleeve gastrectomies. Case presentation The case is a 37 years old female undergoing LSG for treatment for morbid obesity. As is our practice, we routinely perform an intra-operative endoscopy to help ensure a tight seal on the remnant stomach prior to completion of the procedure. During our endoscopy, a blood clot overlying a portion of the esophagus was noted, evacuated and evaluated and found to have a non-bleeding mucosal tear. This was unusual in our experience. There was no leak found on intra-operative endoscopy. After the patient woke up, she starting to have bouts of hematemesis. The decision was made to go back to the OR and evaluate her endoscopically. rather than attempting a laparoscopy based off of our endoscopic findings. Upon take back, we found a mucosal tear in her distal esophagus that now started bleeding, and her staple line was intact. Hemostasis was successfully achieved with two epinephrine injections. The remaining portion of her postoperative course was uncomplicated. Discussion and conclusions The patient was able to be safely managed with a post-operative EGD. The intra-operative endoscopic findings allowed us to be more confident that this was an esophageal issue rather than a staple line problem, and were able to start with EGD prior to laparoscopy. Additionally, from a visualization perspective, the intra-operative endoscopy allows you to fully visualize the staple line, evaluate for twists or narrowing, and test for leak with confidence. From a residency standpoint, it also increases the confidence of residence to perform endoscopy on intubated patients.
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Affiliation(s)
- Ameer Gomberawalla
- Department of Surgery, Presence Saint Joseph Hospital, 2900 N Lake Shore Drive, Chicago, IL 60657 USA ; Chicago Institute of Advanced Bariatrics, Chicago, IL USA
| | - Rami Lutfi
- Chicago Institute of Advanced Bariatrics, Chicago, IL USA
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