Endo Yuichi, Ohta Masayuki, Tada Kazuhiro, Saga Kunihiro, Takayama Hiroomi, Hirashita Teijiro, Uchida Hiroki, Iwashita Yukio, Inomata Masafumi
Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 8795593, Japan.
Surg Today. 2019 Jan;49(1):27-31. doi: 10.1007/s00595-018-1705-0. Epub 2018 Aug 25.
The choice between performing routine and selective upper gastrointestinal endoscopy (UGE) before bariatric surgery remains controversial. This study aimed to evaluate the clinical significance of UGE before laparoscopic bariatric procedures.
We enrolled 155 obese Japanese patients who underwent laparoscopic bariatric procedures at our institute and evaluated their endoscopic findings, such as reflux esophagitis (RE), hiatal hernia (HH), Barrett's esophagus, gastritis, duodenitis, gastroduodenal ulcer, gastric cancer, and polyps.
Preoperative endoscopy revealed abnormal findings in 102 patients (66%), including gastritis in 57 (37%), HH in 51 (32%), RE in 27 (17%), benign gastric polyps in 16 (10%), duodenitis in 6 (4%), and Barrett's esophagus in 1 (0.6%). Two patients with definite HH were treated with simultaneous crural repair at the time of bariatric surgery. Duodenitis was graded as severe in three of these six patients and treated with a proton pump inhibitor before surgery. Eleven patients received therapy to eradicate Helicobacter pylori (H. pylori), either before or after the surgery. In summary, preoperative endoscopy changed the perioperative management for 16 of the 155 patients (10%).
Routine UGE may be necessary before bariatric procedures in obese Japanese patients.
在减重手术前进行常规还是选择性上消化道内镜检查（UGE）仍存在争议。本研究旨在评估腹腔镜减重手术前UGE的临床意义。
我们纳入了155例在我院接受腹腔镜减重手术的肥胖日本患者，并评估了他们的内镜检查结果，如反流性食管炎（RE）、食管裂孔疝（HH）、巴雷特食管、胃炎、十二指肠炎、胃十二指肠溃疡、胃癌和息肉。
术前内镜检查发现102例患者（66%）有异常结果，包括胃炎57例（37%）、HH 51例（32%）、RE 27例（17%）、良性胃息肉16例（10%）、十二指肠炎6例（4%）和巴雷特食管1例（0.6%）。2例确诊HH患者在减重手术时同时进行了膈肌脚修复。这6例患者中有3例十二指肠炎被评为重度，术前用质子泵抑制剂治疗。11例患者在手术前或手术后接受了根除幽门螺杆菌（H. pylori）的治疗。总之，术前内镜检查改变了155例患者中16例（10%）的围手术期管理。
对于肥胖日本患者，减重手术前可能需要进行常规UGE。
