Madan Atul K, Speck Karen E, Hiler M Loyd
Department of Surgery, University of Tennessee-Memphis, Memphis, Tennessee, USA.
Am Surg. 2004 Aug;70(8):684-6.
Upper endoscopy is often performed in patients undergoing bariatric procedures. Various pathologies may be found during upper endoscopy that may change treatment plans for these patients. This study tested the hypothesis that routine use of upper endoscopy is necessary before laparoscopic gastric bypass. All patients in a 6-month period who underwent laparoscopic gastric bypass for the treatment of morbid obesity were reviewed. Demographic data, body mass index (BMI), operative reports, upper endoscopies, and Helicobacter pylori results were reviewed. Documentation of polyps, ulcerations, and hiatal hernias were noted. Hiatal hernias were further classified as small (3.5 to 4.0 cm), medium (4.0 to 4.5 cm), and large (>4.5 cm). All patients (N = 102) had preoperative upper endoscopy. There were 87 female and 15 male patients. BMI ranged from 38.2 to 63.2 (mean, 48.2) and weight ranged from 93 to 232 kg (mean, 133 kg). Hiatal hernia incidences were small, 36.3 per cent; medium, 27.5 per cent; and large, 26.5 per cent. All of these hernias were verified and repaired at time of surgery. Distal esophagitis was noted in 24 per cent of patients. Other pathology (gastric polyps, duodenitis, Schatzki ring) was observed in 5 per cent of patients. Overall, 91 per cent of patients had some type of pathology seen on upper endoscopy. Of the patients tested, 20 per cent were positive for H. pylori and were medically treated. Routine use of preoperative upper endoscopy revealed significant pathology in many patients before laparoscopic gastric bypass. The pathology found modified treatment in many cases. Bariatric surgeons should adopt the routine use of preoperative upper endoscopy during the workup for bariatric surgery.
接受减重手术的患者常需进行上消化道内镜检查。在上消化道内镜检查过程中可能会发现各种病变，这可能会改变这些患者的治疗方案。本研究检验了以下假设：在腹腔镜胃旁路手术前常规进行上消化道内镜检查是必要的。回顾了6个月内所有接受腹腔镜胃旁路手术治疗病态肥胖的患者。查阅了人口统计学数据、体重指数（BMI）、手术报告、上消化道内镜检查结果和幽门螺杆菌检测结果。记录了息肉、溃疡和食管裂孔疝情况。食管裂孔疝进一步分为小（3.5至4.0厘米）、中（4.0至4.5厘米）和大（>4.5厘米）。所有患者（N = 102）均进行了术前上消化道内镜检查。其中女性87例，男性15例。BMI范围为38.2至63.2（平均48.2），体重范围为93至232千克（平均133千克）。食管裂孔疝发生率为：小，36.3%；中，27.5%；大，26.5%。所有这些疝均在手术时得到证实并修复。24%的患者发现有远端食管炎。5%的患者观察到其他病变（胃息肉、十二指肠炎、沙茨基环）。总体而言，91%的患者在上消化道内镜检查中发现了某种类型的病变。在检测的患者中，20%的幽门螺杆菌呈阳性并接受了药物治疗。术前常规进行上消化道内镜检查发现许多患者在腹腔镜胃旁路手术前存在明显病变。所发现的病变在许多情况下改变了治疗方案。减重外科医生在减重手术的检查过程中应采用术前常规上消化道内镜检查。
