Department of Abdominal, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstrasse 20, D-04103, Leipzig, Germany.
Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig, Germany.
Obes Surg. 2020 Jun;30(6):2076-2084. doi: 10.1007/s11695-020-04485-5.
The role of preoperative upper-gastrointestinal (GI) gastroscopy has been discussed with controversy in bariatric surgery. The aim of this study was to evaluate the incidence of upper-GI pathologies detected via endoscopy prior to bariatric surgery along with their clinical significance for patients' management.
In our single center prospectively established database of obese patients, who underwent bariatric surgery from January 2011 to December 2017, we retrospectively analyzed the perioperative endoscopic findings along with their influence on patients' management.
In total, 636 obese patients with median BMI (body mass index) of 49 kg/m [range 31-92] received an upper-GI endoscopy prior to bariatric surgery. Among the surgical procedures, laparoscopic Roux-Y-gastric bypass (72.6%; n = 462) was the most frequent operation. Endoscopically detected pathological conditions were peptic ulcer 3.5% (22/636), Helicobacter pylori (Hp) gastritis 22.4% (143/636), and gastric or duodenal polyps 6.8% (43/636). Reflux esophagitis could be detected in 139/636 patients (21.9%). Barrett's esophagus (BE) was histologically diagnosed in 95 cases (15.0%), whereas BE was suspected endoscopically in 75 cases (11.3%) only. Esophageal adenocarcinomas were detected in 3 cases (0.5%). Change of the operative strategy due to endoscopically or histologically detected pathologic findings had to be performed in 10 cases (1.6%).
Preoperative upper-GI endoscopy identifies a wide range of abnormal endoscopic findings in obese patients, which may have a significant impact on decision-making, particularly regarding the most suitable bariatric procedure and the appropriate follow-up. Therefore, preoperative upper-GI endoscopy should be considered in all obese patients prior to bariatric procedure.
术前上消化道（GI）胃镜检查在减肥手术中的作用一直存在争议。本研究旨在评估减肥手术前通过内镜检查发现的上消化道病变的发生率及其对患者管理的临床意义。
在我们的单中心前瞻性肥胖患者数据库中，我们回顾性分析了 2011 年 1 月至 2017 年 12 月期间接受减肥手术的患者的围手术期内镜检查结果及其对患者管理的影响。
共有 636 名肥胖患者（中位 BMI [体重指数] 49kg/m [范围 31-92]）在减肥手术前接受了上消化道内镜检查。手术中，腹腔镜 Roux-Y 胃旁路术（72.6%；n=462）是最常见的手术。内镜检查发现的病理情况为消化性溃疡 3.5%（22/636）、幽门螺杆菌（Hp）胃炎 22.4%（143/636）和胃或十二指肠息肉 6.8%（43/636）。反流性食管炎可在 139/636 例患者（21.9%）中检测到。组织学诊断 Barrett 食管（BE）95 例（15.0%），仅内镜检查怀疑 BE75 例（11.3%）。食管腺癌 3 例（0.5%）。由于内镜或组织学检查发现的病理发现而改变手术策略的有 10 例（1.6%）。
术前上消化道内镜检查可识别肥胖患者广泛的异常内镜表现，这可能对决策产生重大影响，尤其是对最合适的减肥手术和适当的随访。因此，在进行减肥手术前，应考虑对所有肥胖患者进行术前上消化道内镜检查。
