Routine preoperative upper endoscopy for laparoscopic gastric bypass: is it necessary?

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.