Is oesophagogastroduodenoscopy prior to Roux-en-Y gastric bypass surgery mandatory?
Abstract
Background and study aims: Roux-Y Gastric Bypass is one of the most frequently used
techniques in bariatric surgery for morbidly obese patients. Postoperative anatomy is altered by
exclusion of the stomach which makes this organ inaccessible for future
Esophagogastroduodenoscopy (EGD). There is no definite consensus about preoperative
assessment of the stomach. Some institutions choose to investigate the future remnant stomach
by EGD, others do not. Aim of the present study is to quantify the yield of preoperative EGD in
our institution.
Methods: Patients, who were planned for laparoscopic Roux-Y Gastric Bypass (LRYGB) from
December 2007 until August 2012, were screened by EGD in advance. These files were
retrospectively reviewed for results of the EGD. In addition the files were searched for
comorbidities, medication and other patient characteristic. All these data were analyzed.
Results: 664 patients (136 male, 526 female, median age 44.2 years, average BMI 45.6)
underwent preoperative EGD. In 341 cases no abnormalities were found (A), 115 patients had
findings that did not have consequences (B1), 112 (of 417) patients needed HP eradication
therapy (B2), 87 patients needed preoperative treatment by proton pump inhibitors (B3), and 6
patients needed follow up EGD before the surgery (C). For one patient the operation was
cancelled because preoperative EGD showed Barrett’s esophagus with carcinoma (D). When all
abnormalities are taken into account, baselines show a significant difference for age, gender,
hypertension and alcohol. Regarding the treatment consequences, the number needed to treat to
find one serious abnormality (postponing/ follow up EGD or cancel operation) is 94,5.
Conclusion: Based on our results and the results in the literature we state that standard
preoperative assessment by EGD is questionable. The number needed to treat for abnormalities
with treatment consequences is high. Undergoing EGD for patients without sedation is not to be
taken lightly and also the economic burden of performing EGD in all patients is noteworthy.
Authors: U.K. Coblijn M.D1., A. Schigt M.D.1, S.M. Lagarde M.D. PhD.1, P. Scholten M.D.1 , S.D.
Kuiken M.D. PhD.2, B.A. van Wagensveld M.D. PhD.1
1=
2
Department of Surgery Sint Lucas Andreas Hospital
= Department of Gastroenterology Sint Lucas Andreas Hospital
U.K. Coblijn, Submission Digestive Disease Week,
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