Elkin Baila, El-Dahdah Joseph, Yang Qijun, Wu Yueqi, McMichael John, Kim Michelle Kang, Corcelles Codina Ricard, Simons Linares Carlos Roberto, Rouphael Carol
Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
Obes Surg. 2025 Jun 5. doi: 10.1007/s11695-025-07958-7.
The role of routine esophagogastroduodenoscopy (EGD) before metabolic bariatric surgery (MBS) remains unclear. We examined which patients were more likely to undergo preoperative EGD with biopsies, assessed the prevalence of clinically significant gastric pathologies on surgical specimens that may have been missed preoperatively, and analyzed patient factors associated with those findings.
Patients ≥ 18 years old with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2018 and 2022 were included. Demographic, clinical, endoscopic, and pathology (from EGD and surgical specimens) characteristics were collected. Descriptive statistics were used. Uni- and multivariable Cox regression analyses assessed factors associated with clinically significant endoscopic and pathology findings.
Of 3718 patients (38.8% RYGB, 61.2% SG), 80% were female, 69.9% White, and 12.6% Hispanic. Median age at surgery was 45.7 years; median body mass index was 44.5 kg/m. Preoperative EGD was performed in 36.9% of patients. Surgical specimens were available for 2349 patients (2273 SG and 76 RYGB), among whom 135 had clinically significant pathology. 63.7% of these patients had no preoperative EGD, 15.6% had preoperative EGD without biopsies, and 20.7% preoperative EGD with biopsies. Older age and non-White, non-Black race were associated with clinically significant findings on EGD or pathology.
Several clinically relevant gastric pathologies could have been detected preoperatively via EGD with biopsies, yet about two-thirds did not undergo this evaluation. Older age and non-White, non-Black race were associated with these findings. Further research is needed to assess predictive factors of significant findings and cost-effectiveness of routine versus selective pre-operative EGD.
代谢性减重手术（MBS）前常规食管胃十二指肠镜检查（EGD）的作用仍不明确。我们研究了哪些患者更有可能接受术前EGD及活检，评估了手术标本上可能术前漏诊的具有临床意义的胃部病变的患病率，并分析了与这些发现相关的患者因素。
纳入2018年至2022年间年龄≥18岁且接受了Roux-en-Y胃旁路术（RYGB）或袖状胃切除术（SG）的患者。收集人口统计学、临床、内镜及病理（来自EGD和手术标本）特征。采用描述性统计。单变量和多变量Cox回归分析评估与具有临床意义的内镜及病理发现相关的因素。
在3718例患者中（38.8%为RYGB，61.2%为SG），80%为女性，69.9%为白人，12.6%为西班牙裔。手术时的中位年龄为45.7岁；中位体重指数为44.5kg/m²。36.9%的患者进行了术前EGD。2349例患者（2273例SG和76例RYGB）有手术标本，其中135例有具有临床意义的病理改变。这些患者中63.7%未进行术前EGD，15.6%进行了术前EGD但未活检，20.7%进行了术前EGD并活检。年龄较大以及非白人、非黑人种族与EGD或病理检查中的具有临床意义的发现相关。
通过EGD及活检可能在术前检测到几种具有临床相关性的胃部病变，但约三分之二的患者未接受此项评估。年龄较大以及非白人、非黑人种族与这些发现相关。需要进一步研究以评估重要发现的预测因素以及常规与选择性术前EGD的成本效益。
