Zidan Mohamed H, Abokhozima Ahmed, Gaber Mohannad I A, Amgad Ahmed, Altabbaa Hashem, El-Masry Hassan, Alokl Mohammed, Ali Reda Fawzy, Elmagd Ahmed Abo, Selim Aliaa, Gawdat Khaled
Alexandria University, Alexandria, Egypt.
Alexandria Main University Hospital, Alexandria University, Alexandria, Egypt.
Obes Surg. 2025 May 20. doi: 10.1007/s11695-025-07846-0.
Esophagogastroduodenoscopy (EGD) is crucial in bariatric surgery for detecting gastro-esophageal conditions and incidental pathologies, impacting surgical decisions and outcomes. The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) recommends routine EGD before and after bariatric procedures to identify incidental pathologies. However, global adherence to these guidelines varies, especially in resource-constrained settings where economic limitations often dictate practice patterns. This study adapts a survey by Quake et al. (2022) to the Egyptian context, offering a comprehensive analysis of EGD utilization alongside broader trends in metabolic and bariatric surgery (MBS) practices in Egypt.
A survey adapted from Quake et al. (2022) was tailored to assess trends in metabolic and bariatric surgery (MBS) practices in Egypt. Conducted between April and August 2024 with a response rate of 53.3%, the survey targeted Egyptian bariatric surgeons. It evaluated EGD utilization, surgical expertise, institutional volumes, types of procedures, revisional surgeries, and adherence to the 2020 IFSO position statement. Data was collected through Google Forms and analyzed for trends, challenges, and gaps in practice, focusing on economic constraints and guideline implementation.
Among the 80 respondents, 88.8% were consultants, with 73.8% performing over 100 surgeries annually. The volume of bariatric procedures increased from 2021 to 2023, with significant growth in sleeve gastrectomy (SG) and single-anastomosis sleeve ileal (SASI) bypasses/bipartition. Revisional surgeries were most commonly Roux-en-Y gastric bypass (RYGB). Despite this growth, EGD utilization remained limited. Pre-operatively, only 12.5% of surgeons performed EGD routinely for all patients, while 67.5% used it selectively based on patient or procedural factors. Post-operative EGD at one year was routinely offered by just 3.8% of surgeons, with 55% not routinely using it at all. Institutional and economic factors influenced these practices; surgeons in high-volume or private settings were more likely to adopt selective EGD use. Awareness of the 2020 IFSO guidelines showed a minimal impact on EGD practices, suggesting that financial considerations often outweigh clinical recommendations.
This study highlights critical trends in bariatric surgery practices in Egypt, including increasing procedural volumes and the limited utilization of EGD. Economic constraints remain the predominant barrier to routine EGD use, despite its potential to improve surgical outcomes by identifying incidental pathologies. Enhancing patient care requires establishing a national registry, upgrading training programs, and implementing observerships to align with international standards are pivotal in advancing bariatric care in Egypt and guaranteeing high-caliber, evidence-based patient care.
食管胃十二指肠镜检查（EGD）在减肥手术中对于检测胃食管疾病和偶然发现的病变至关重要，会影响手术决策和结果。国际肥胖和代谢疾病外科联合会（IFSO）建议在减肥手术前后进行常规EGD检查，以识别偶然发现的病变。然而，全球对这些指南的遵守情况各不相同，尤其是在资源有限的环境中，经济限制往往决定了实践模式。本研究将Quake等人（2022年）的一项调查适用于埃及的情况，对EGD的使用情况以及埃及代谢和减肥手术（MBS）实践的更广泛趋势进行了全面分析。
一项改编自Quake等人（2022年）的调查旨在评估埃及代谢和减肥手术（MBS）的实践趋势。该调查于2024年4月至8月进行，回复率为53.3%，目标是埃及的减肥外科医生。它评估了EGD的使用情况、手术专业知识、机构手术量、手术类型、翻修手术以及对2020年IFSO立场声明的遵守情况。数据通过谷歌表单收集，并分析了实践中的趋势、挑战和差距，重点关注经济限制和指南的实施情况。
在80名受访者中，88.8%是顾问医生，73.8%的人每年进行超过100例手术。从2021年到2023年，减肥手术的数量有所增加，袖状胃切除术（SG）和单吻合口袖状回肠（SASI）旁路/二分术有显著增长。翻修手术最常见的是Roux-en-Y胃旁路术（RYGB）。尽管有这种增长，但EGD的使用仍然有限。术前，只有12.5%的外科医生对所有患者常规进行EGD检查，而67.5%的医生根据患者或手术因素选择性地使用它。术后一年常规进行EGD检查的外科医生仅占3.8%，55%的医生根本不常规使用。机构和经济因素影响了这些做法；手术量大或私立机构的外科医生更有可能采用选择性EGD使用。对2020年IFSO指南的知晓对EGD实践的影响微乎其微，这表明经济因素往往超过临床建议。
本研究突出了埃及减肥手术实践中的关键趋势，包括手术量的增加和EGD使用的有限性。尽管EGD有可能通过识别偶然发现的病变来改善手术结果，但经济限制仍然是常规使用EGD的主要障碍。加强患者护理需要建立国家登记册、升级培训项目并实施观摩实习，以符合国际标准，这对于推进埃及的减肥护理和确保高质量、基于证据的患者护理至关重要。
