Pre-operative work-up before bariatric surgery: Should ultrasonography and upper gastrointestinal endoscopy be done routinely?

Aim: The objective of this research was to clarify whether routine upper gastrointestinal endoscopy and abdominal ultrasound examination before bariatric surgery affect the surgical plan in our bariatric center.Material and Methods: Bariatric surgery was performed in 320 patients between January 2015 and February 2018 in our bariatric center. The files of 185 patients who underwent upper abdominal ultrasonography and upper endoscopy in the preoperative workup period were assessed retrospectively. Collected data; age, gender, BMI before operation, sonographic findings, endoscopic findings, and subsequent follow-up plan. The patients were seperated into four groups regarding sonographic and upper endoscopy findings.Results: The mean age of the participants was 41.01, 65 (35.1%) were female and 120 (63.9%) were male. The mean BMI was 42.2 kg/m2. Ultrasound was found normal in 75 participants (40.5%) and one or multipl abnormal findings were detected in 110 patients (59.5%). The procedure was delayed or canceled for patients (2.1%) according to the sonographic findings which required workup and treatment before surgery. Normal endoscopy without findings appeared in 47 participants (25.4%) while one or more abnormal findings was appeared in 138 patients (74.6%). Patients who had serious esophagitis, gastroesophageal reflux disease, grade D esophagitis or wide hiatus hernias were treated on regime change and proton pump inhibitor drugs but these circumstances were contemplated to be an evaluation for gastric bypass and a inappropriate for sleeve gastrectomy.Conclusions: Ultrasound findings affected the offered surgical timing in 3 (2.1%) of 185 patients reviewed and should be reserved for symptomatic patients only. Depending on the abnormal abnormalities in the gastroscopy, the procedure was canceled, altered or deferred at 48.4%. We suggest that endoscopy should be performed routinely in light of these results.

PDF

___

1. Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg 2003;13:329-30.
2. Lee J, Wong SK, Liu SY, et al. Is preoperative upper gastrointestinal endoscopy in obese patients undergoing bariatric surgery mandatory? An Asian perspective Obes Surg 2017;27:44-50.
3. Sauerland S, Angrisani L, Belachew M, et al. Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 2005;19:200-21.
4. Abd Ellatif ME, Alfalah H, Asker WA, et al. Place of upper endoscopy before and after bariatric surgery: A multicenter experience with 3219 patients. World J Gastrointest Endosc 2016;8:409-17.
5. Mechanick JI, Youdim A, Jones D, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American society for Metabolic & bariatric surgery. Endocr Pract 2013;19:338-72.
6. SAGES Guidelines Committee. Guidelines for clinical application of laparoscopic bariatric surgery. Surg Endosc 2008;22:2281-300.
7. de Moura Almeida A, Cotrim HP, Barbosa DB, et al. Fatty liver disease in severe obese patients: diagnostic value of abdominal ultrasound. World J Gastroenterol 2008;14:1415-8.
8. Papasavas PK, Gagne DJ, Ceppa FA, et al. Routine gallbladder screening not necessary in patients undergoing laparoscopic roux-en-Y gastric bypass. Surg Obes Relat Dis 2006;2:41-6.
9. Abou Hussein BM, Khammas A, Makki M, et al. Role of Routine Abdominal Ultrasound Before Bariatric Surgery: Review of 937 Patients. Obes Surg 2018;28:2696-9.
10. Merrouche M, Sabaté JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg 2007;17:894-900.
11. Greenstein RJ, Nissan A, Jaffin B. Esophageal anatomy and function in laparoscopic gastric restrictive bariatric surgery: implications for patient selection. Obes Surg 1998;8:199-206.
12. ASGE Standards of Practice Committee. The role of endoscopy in the bariatric surgery patient. Gastrointest Endosc 2015;81:1063-72.
13. Sauerland S, Angrisani L, Belachew M, et al. Obesity surgery: evidencebased guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 2005;19:200-21.
14. Frigg A, Peterli R, Zynamon A et al. Radiologic and endoscopic evaluation for laparoscopic adjustable gastric banding: preoperative and follow-up. Obes Surg 2001;11:594-9.
15. Sharaf RN, Weinshel EH, Bini EJ et al. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg 2004;14:1367-72.
16. Abou Hussein B, Khammas A, Shokr M, et al. Badri F. Role of routine upper endoscopy before bariatric surgery in the Middle East population: a review of 1278 patients. Endosc Int Open. 2018;6:E1171-E6.
17. Bennett S, Gostimir M, Shorr R, et al. The role of routine preoperative upper endoscopy in bariatric surgery: a systematic review and metaanalysis. Surg Obes Relat Dis 2016;12:1116-25
18. Korenkov M, Köhler L, Yücel N et al. Esophageal motility and reflux symptoms before and after bariatric surgery. Obes Surg 2002;12:72-6
19. Miller K, Hell E. Laparoscopic surgical concepts of morbid obesity. Langenbecks Arch Surg 2003;388:375-84.