Chen Jennwood, Razzouk Jacob, Martinez Paige, Kohler Rebecca, Morrow Ellen, Ibele Anna, Volckmann Eric
Department of Surgery, University of Utah, 1280 East Stringham Ave, Salt Lake City, UT, 84106, USA.
School of Medicine, Loma Linda University, Loma Linda, CA, USA.
Surg Endosc. 2023 Apr;37(4):3127-3135. doi: 10.1007/s00464-022-09485-3. Epub 2022 Aug 8.
Our aim was to evaluate the diagnostic yield of routine preoperative esophagogastroduodenoscopy (p-EGD) in patients undergoing bariatric surgery. Many medical problems that are common in patients with obesity, including gastroesophageal reflux disease (GERD) and hiatal hernias, have important implications for patients undergoing bariatric surgery. While p-EGD is considered standard of care prior to antireflux surgery, the role of p-EGD in bariatric surgery patients remains controversial.
We performed a retrospective chart review of 885 patients who underwent primary bariatric surgery at a university hospital-based bariatric surgery program between March 2011 and February 2022. Clinical history, demographics, and preoperative EGD reports were reviewed for abnormal findings.
Of the 885 patients evaluated in this study, one or more abnormal EGD findings were observed in 83.2% of patients. More than half of our patients (54.7%) presented with history of heartburn, reflux, or GERD. EGD findings demonstrated a hernia in 43.1% of patients [(Type I: 40.6%; Type II: 0.5%; Type III: 2.1%)]. 68.0% of patients were biopsied. Among patients who were biopsied, other findings included gastritis (32.4%), esophagitis (8.0%), eosinophilic esophagitis (4.7%), or duodenitis (2.7%). We found ulcers in 6.7% of patients. Pathology was consistent with H. pylori in 9.8% of biopsies taken and consistent with BE in 2.7%. Following routine p-EGD, 11.2% of patients were placed on PPI and 8.3% were recommended to stop NSAIDs.
Gastroesophageal reflux disease and associated pathology are common in the bariatric population. Preoperative EGD in patients undergoing bariatric surgery frequently identifies clinically significant UGI pathology. This may have important implications for medical and surgical management. Given the rate of abnormal preoperative endoscopic findings in obese patients, the work-up for bariatric surgery should align with the current recommendations for foregut surgery.
我们的目的是评估在接受减肥手术的患者中，常规术前食管胃十二指肠镜检查（p-EGD）的诊断率。肥胖患者中常见的许多医学问题，包括胃食管反流病（GERD）和食管裂孔疝，对接受减肥手术的患者具有重要影响。虽然p-EGD被认为是抗反流手术前的标准治疗方法，但p-EGD在减肥手术患者中的作用仍存在争议。
我们对2011年3月至2022年2月期间在一家大学医院的减肥手术项目中接受初次减肥手术的885例患者进行了回顾性病历审查。审查临床病史、人口统计学资料和术前EGD报告以查找异常发现。
在本研究评估的885例患者中，83.2%的患者观察到一项或多项EGD异常发现。超过一半的患者（54.7%）有烧心、反流或GERD病史。EGD检查发现43.1%的患者有疝（I型：40.6%；II型：0.5%；III型：2.1%）。68.0%的患者接受了活检。在接受活检的患者中，其他发现包括胃炎（32.4%）、食管炎（8.0%）、嗜酸性食管炎（4.7%）或十二指肠炎（2.7%）。我们发现6.7%的患者有溃疡。9.8%的活检病理结果与幽门螺杆菌一致，2.7%与巴雷特食管一致。在常规p-EGD检查后，11.2%的患者开始使用质子泵抑制剂（PPI），8.3%的患者被建议停用非甾体抗炎药（NSAIDs）。
胃食管反流病及相关病变在减肥人群中很常见。减肥手术患者的术前EGD检查经常能发现具有临床意义的上消化道病变。这可能对药物和手术治疗具有重要意义。鉴于肥胖患者术前内镜检查异常的发生率，减肥手术的检查应符合当前前肠手术的建议。
