Division of Minimally Invasive and Elective General Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas; UT Physicians, The Davis Clinic at Memorial Hermann-Memorial City Medical Center, Houston, Texas.
Division of Minimally Invasive and Elective General Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas; Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, Texas.
Surg Obes Relat Dis. 2020 Jun;16(6):745-750. doi: 10.1016/j.soard.2020.02.002. Epub 2020 Feb 14.
The role of routine preoperative endoscopy before primary weight loss surgery remains controversial.
We reviewed our experience to determine the frequency of abnormal findings in patients undergoing routine preoperative endoscopy before bariatric surgery.
A tertiary level, academic-affiliated bariatric surgery practice.
A retrospective chart review was performed between July 2014 and June 2016 of patients undergoing routine preoperative endoscopy before primary bariatric surgery. Variables evaluated included preendoscopy symptoms, planned bariatric surgical procedure, abnormal findings on endoscopy, and changes in planned bariatric surgical procedure after endoscopy.
A total of 631 patients met inclusion criteria. Of patients, 72% (457) were female. The median age was 44 (interquartile range 36-55). The median body mass index was 46 (interquartile range 42-51). Most patients had no preendoscopy clinical symptoms (61.3%). The most frequent abnormal findings included esophagitis (26.5%), hiatal hernia (27.1%), gastric ulcer (4.9%), and biopsy-proven Barrett's esophagus (4.6%). Although patients with preoperative symptoms were more likely to have abnormal findings on endoscopy, there were no significant differences in rates of Barrett's esophagus in patients with (5.3%) or without (4.1%) symptoms. Of the total cohort, 18.4% had a change in their planned operation after endoscopy results.
The findings in our large series suggest selective screening in symptomatic patients only may lead to failure of discovery of foregut pathology that should prompt consideration for changes in the planned bariatric surgical procedure. Further study is necessary to see if our findings have broad applicability.
在主要减肥手术前进行常规术前内镜检查的作用仍存在争议。
我们回顾了我们的经验，以确定在接受减肥手术前进行常规术前内镜检查的患者中异常发现的频率。
三级学术附属减肥手术实践。
对 2014 年 7 月至 2016 年 6 月期间接受原发性减肥手术前常规术前内镜检查的患者进行回顾性图表审查。评估的变量包括内镜检查前的症状、计划的减肥手术程序、内镜检查中的异常发现以及内镜检查后计划的减肥手术程序的变化。
共有 631 名患者符合纳入标准。其中 72%（457 名）为女性。中位年龄为 44 岁（四分位距 36-55 岁）。中位体重指数为 46 （四分位距 42-51）。大多数患者无内镜检查前的临床症状（61.3%）。最常见的异常发现包括食管炎（26.5%）、食管裂孔疝（27.1%）、胃溃疡（4.9%）和活检证实的巴雷特食管（4.6%）。尽管有术前症状的患者更有可能在内镜检查中发现异常，但有症状（5.3%）和无症状（4.1%）患者的巴雷特食管发生率无显著差异。在总队列中，18.4%的患者在接受内镜检查结果后改变了他们的计划手术。
我们的大型系列研究结果表明，仅对有症状的患者进行选择性筛查可能会导致未能发现应促使考虑改变减肥手术计划的前肠病理学。需要进一步研究以确定我们的发现是否具有广泛的适用性。
