袖状胃切除术和 Roux-en-Y 胃旁路术前是否需要行胃镜检查？
Is preoperative gastroscopy necessary before sleeve gastrectomy and Roux-en-Y gastric bypass?
机构信息
Helsinki University Hospital, Abdominal Center, Department of Gastrointestinal Surgery, helsinki, Finland; Obesity Research Unit, Research Programs Unit, Diabetes and Obesity, University of Helsinki, Biomedicum Helsinki, Helsinki, Finland.
Helsinki University Hospital, Abdominal Center, Department of Gastrointestinal Surgery, helsinki, Finland; Obesity Research Unit, Research Programs Unit, Diabetes and Obesity, University of Helsinki, Biomedicum Helsinki, Helsinki, Finland.
出版信息
Surg Obes Relat Dis. 2018 Jun;14(6):757-762. doi: 10.1016/j.soard.2018.01.021. Epub 2018 Feb 14.
BACKGROUND
Consensus on the necessity of esophagogastroduodenoscopy (EGD) before bariatric surgery is lacking. Recommendations and practices vary by country and unit. Several reports have expressed concerns on gastroesophageal reflux disease (GERD) and its consequences after sleeve gastrectomy (SG) and the risk of leaving a premalignant lesion in the excluded stomach after Roux-en-Y gastric bypass (RYGB).
OBJECTIVES
We explored the number and types of clinically significant findings in preoperative EGDs and how they associate with preexisting GERD-symptoms (SG) and premalignant lesions (RYGB). We also studied how many reoperations were performed due to postoperative GERD in SG-patients.
SETTING
University hospital.
METHODS
We investigated preoperative EGD-findings and gastrointestinal symptoms before bariatric surgery in all patients with a primary bariatric operation in our unit between December 2007 and May 2016.
RESULTS
We performed 1474 operations: 1047 (71.0%) RYGB, 407 (27.6%) SG, and 20 (1.4%) others. One thousand two hundred seventy-five (86.5%) preoperative EGD reports were analyzed: 647 (50.7%) EGDs were completely normal. Altogether, 294 patients (23.0% of total) had a clinically significant finding that was relevant for SG (hiatal hernia, esophagitis, Barrett's esophagus, esophageal dysplasia), 144 (49.0%) of whom reported gastrointestinal symptoms. Twenty patients (1.6%) had a significant finding relevant for RYGB (peptic ulcer, atrophic gastritis, gastrointestinal stromal tumor), and 6 (30%) reported gastrointestinal symptoms. Thirteen (3.2%) SGs were converted into RYGB due to GERD.
CONCLUSIONS
Preoperative EGD is indicated before SG but not before RYGB for asymptomatic patients without a risk for gastric pathology.
背景
在减重手术前是否需要进行食管胃十二指肠镜检查（EGD）尚无共识。建议和做法因国家和单位而异。有几份报告对袖状胃切除术（SG）后胃食管反流病（GERD）及其后果以及 Roux-en-Y 胃旁路术（RYGB）后排除胃中存在癌前病变的风险表示担忧。
目的
我们探讨了术前 EGD 中临床显著发现的数量和类型，以及它们与术前存在的 GERD 症状（SG）和癌前病变（RYGB）的关联。我们还研究了由于 SG 患者术后 GERD 而进行了多少次再手术。
设置
大学医院。
方法
我们调查了 2007 年 12 月至 2016 年 5 月期间我院所有初次减重手术患者的术前 EGD 检查结果和胃肠道症状。
结果
我们进行了 1474 例手术：1047 例（71.0%）RYGB、407 例（27.6%）SG 和 20 例（1.4%）其他手术。分析了 1275 份（86.5%）术前 EGD 报告：647 份（50.7%）EGD 完全正常。总共 294 例患者（占总数的 23.0%）有临床意义的发现与 SG 相关（食管裂孔疝、食管炎、Barrett 食管、食管发育不良），其中 144 例（49.0%）报告有胃肠道症状。20 例患者（1.6%）有与 RYGB 相关的重要发现（消化性溃疡、萎缩性胃炎、胃肠道间质瘤），其中 6 例（30%）报告有胃肠道症状。由于 GERD，13 例（3.2%）SG 转为 RYGB。
结论
对于无症状且无胃病理风险的患者，SG 术前需要进行 EGD，但 RYGB 术前不需要进行 EGD。
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