Kanat Burhan Hakan, Doğan Serhat
Department of General Surgery, Malatya Turgut Özal University, School of Medicine, Malatya 44100, Turkey.
World J Gastrointest Endosc. 2022 Jan 16;14(1):29-34. doi: 10.4253/wjge.v14.i1.29.
Obesity is the abnormal accumulation of fat or adipose tissue in the body. It has become a serious health problem in the world in the last 50 years and is considered a pandemic. Body mass index is a widely used classification. Thus, obese individuals can be easily classified and standardized. Obesity is the second cause of preventable deaths after smoking. Obesity significantly increases mortality and morbidity. We thought of preparing a publication about routine procedures for the preoperative evaluation of obesity. The question that we asked as bariatric and metabolic surgeons but which was not exactly answered in the literature was "Is esophagogastroduodenoscopy (EGD) necessary before bariatric surgery?" We found different answers in our literature review. The European Association of Endoscopic Surgery guidelines recommend EGD for all bariatric procedures. They strongly recommend it for Roux-en-Y gastric bypass (RYGB). As a result of a recent study by the members of the British Obesity & Metabolic Surgery Society, preoperative EGD is routinely recommended for patients undergoing sleeve gastrectomy, even if they are asymptomatic, but not recommended for RYGB. It is recommended for symptomatic patients scheduled for RYGB. According to the International Sleeve Gastrectomy Expert Panel Consensus Statement, preoperative EGD is definitely recommended for patients scheduled for sleeve gastrectomy, but its routine use for RYGB is controversial. However, a different view is that the American Society for Gastrointestinal Endoscopy recommends endoscopy only for symptomatic patients scheduled for bariatric surgery. In the literature, the primary goal of EGD recommended for sleeve gastrectomy has been interpreted as determining esophagitis caused by gastroesophageal reflux. In the light of the literature, it is stated that this procedure is not necessary in America, while it is routinely recommended in the European continent. Considering medicolegal cases that may occur in the future, we are in favor of performing EGD before bariatric surgery. In conclusion, EGD before bariatric surgery is insurance for both patients and physicians. There is a need for larger and prospective studies to reach more precise conclusions on the subject.
肥胖是体内脂肪或脂肪组织的异常蓄积。在过去50年里，肥胖已成为全球一个严重的健康问题，被视为一种大流行病。体重指数是一种广泛使用的分类方法。因此，肥胖个体能够很容易地被分类和标准化。肥胖是仅次于吸烟的可预防死亡的第二大原因。肥胖显著增加死亡率和发病率。我们曾考虑编写一份关于肥胖症术前评估常规程序的出版物。作为减重与代谢外科医生，我们提出的一个问题在文献中并未得到确切解答，即“减重手术前是否需要进行食管胃十二指肠镜检查（EGD）？”我们在文献综述中找到了不同的答案。欧洲内镜外科学会指南建议对所有减重手术都进行EGD检查。对于Roux-en-Y胃旁路术（RYGB），他们强烈推荐进行此项检查。英国肥胖与代谢外科学会成员最近的一项研究结果显示，对于接受袖状胃切除术的患者，即使无症状，常规也建议术前进行EGD检查，但对于RYGB则不建议。对于计划接受RYGB的有症状患者，建议进行此项检查。根据国际袖状胃切除术专家小组共识声明，对于计划接受袖状胃切除术的患者，肯定建议术前进行EGD检查，但其在RYGB中的常规应用存在争议。然而，另一种观点是，美国胃肠内镜学会仅建议对计划接受减重手术的有症状患者进行内镜检查。在文献中，推荐对袖状胃切除术进行EGD检查的主要目的被解释为确定由胃食管反流引起的食管炎。根据文献，在美国，该检查被认为没有必要，而在欧洲大陆则常规推荐。考虑到未来可能出现的医疗法律案件，我们支持在减重手术前进行EGD检查。总之，减重手术前的EGD检查对患者和医生而言都是一种保障。需要开展更大规模的前瞻性研究，以便就该主题得出更精确的结论。
