Allotey Jonathan, Caposole Michael, Attia Abdallah, Coonan Erin, Noguera Valeria, Lewis Emma, Bloomenthal Molly S, Issa Peter, Omar Mahmoud, Aboueisha Mohamed, Crisp Benjamin, Baker John, Levy Shauna, Galvani Carlos
Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA.
Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA.
Surg Endosc. 2023 Dec;37(12):9572-9581. doi: 10.1007/s00464-023-10388-0. Epub 2023 Sep 20.
There is an ongoing debate on how to best identify patients with gastroesophageal reflux disease (GERD) before bariatric surgery. The value of routine preoperative esophagogastroduodenoscopy (EGD) is questioned, and patient reported symptoms are commonly used for screening. The goal of this study is to determine if patient reported symptoms using a validated questionnaire correlate with preoperative EGD findings.
A prospective cohort study at a single institution was performed. Patients undergoing bariatric surgery between December 2020 and March 2023 were required to report symptoms of reflux by completing a preoperative GERD. Health-Related Quality of Life (GERD-HRQL) questionnaire and undergo a mandatory preoperative screening EGD. Patients were stratified into two cohorts: (group A) asymptomatic (score = 0) and (group B) symptomatic (score > 0). Statistical analysis was conducted using Pearson's chi-squared test and Wilcoxon rank-sum test in RStudio version 4.2.2. The predictive value of the GERD-HRQL score was analyzed using Areas Under the Curve (AUC; AUC = 0.5 not predictive, 0.5 < AUC ≥ 6 poor prediction & AUC > 0.9 excellent prediction) calculated from Receiver Operating Characteristic (ROC) curves.
200 patients were included; median age was 42.0 years (IQR 36.0 to 49.2). There were 79 patients (39.5%) in Group A and 121 patients (60.5%) in Group B. There was no difference in the frequency esophagitis (27.8% vs 32.2%, p = 0.61) or hiatal hernias (49.4% vs 47.1%, p = 0. 867) between group A and group B, respectively. ROC analysis revealed that the total GERD HRQL scores, heartburn only scores and regurgitation only scores, were poor predictors of esophagitis found on EGD (AUC 0.52, 0.53, 0.52), respectively. In asymptomatic patients, higher BMI was significantly associated with esophagitis (OR 1.15, 95% CI 1.06-1.27, p = 0.002).
Symptoms, identified through the GERD-HRQL questionnaire, are a poor indicator of esophagitis or its severity in patients undergoing workup for bariatric surgery. Therefore, liberal screening upper endoscopy is recommended for pre-bariatric surgery patients to guide appropriate procedure selection.
关于如何在减肥手术前最佳地识别胃食管反流病（GERD）患者，目前仍存在争议。常规术前食管胃十二指肠镜检查（EGD）的价值受到质疑，患者报告的症状通常用于筛查。本研究的目的是确定使用经过验证的问卷报告的患者症状是否与术前EGD检查结果相关。
在单一机构进行了一项前瞻性队列研究。2020年12月至2023年3月期间接受减肥手术的患者需要通过完成术前GERD健康相关生活质量（GERD-HRQL）问卷来报告反流症状，并接受强制性术前筛查EGD。患者被分为两个队列：（A组）无症状（得分=0）和（B组）有症状（得分>0）。在RStudio 4.2.2版本中使用Pearson卡方检验和Wilcoxon秩和检验进行统计分析。使用从受试者工作特征（ROC）曲线计算的曲线下面积（AUC；AUC=0.5无预测价值，0.5<AUC≥0.6预测性差，AUC>0.9预测性极佳）分析GERD-HRQL评分的预测价值。
纳入200例患者；中位年龄为42.0岁（四分位间距36.0至49.2）。A组有79例患者（39.5%），B组有121例患者（60.5%）。A组和B组之间食管炎的发生率（27.8%对32.2%，p=0.61）或食管裂孔疝的发生率（49.4%对47.1%，p=0.867）没有差异。ROC分析显示，GERD HRQL总分、仅烧心评分和仅反流评分分别是EGD检查发现食管炎的不良预测指标（AUC分别为0.52、0.53、0.52）。在无症状患者中，较高的BMI与食管炎显著相关（OR 1.15，95%CI 1.06-1.27，p=0.002）。
通过GERD-HRQL问卷确定的症状，对于接受减肥手术检查的患者来说，是食管炎或其严重程度的不良指标。因此，建议对减肥手术患者进行宽松的筛查性上消化道内镜检查，以指导合适的手术选择。
