Clinical Report: Preoperative Upper-GI Endoscopy in Bariatric Surgery
Overview
This study assessed the prevalence and clinical relevance of upper-GI endoscopic findings in 636 bariatric surgery patients. Key findings included a high prevalence of gastritis (68.7%), hiatal hernia (32.5%), and esophagitis (21.9%), with some findings influencing perioperative and operative strategies.
Background
Morbid obesity is associated with multiple upper-GI tract diseases such as gastritis, hiatal hernia, GERD, and Barrett’s esophagus. Bariatric surgery is the most effective treatment for morbid obesity after failure of conservative therapies. Preoperative upper-GI endoscopy aims to optimize surgical planning and improve outcomes, but its routine use remains controversial. Guidelines differ internationally on whether endoscopy should be performed routinely or selectively before bariatric surgery.
Data Highlights
Parameter
Value
Number of patients
636
Median age (years)
49 (range 13–75)
Median BMI (kg/m2)
49 (range 31–92)
Male patients
214 (33.6%)
Female patients
422 (66.4%)
Main bariatric procedure (LRYGB)
462 (72.6%)
LSG procedures
128 (20.1%)
Re-do operations
42 (6.6%)
Hiatal hernia detected intraoperatively
96 (15.1%)
LSG converted to other procedures
34 (5.3%)
Gastritis (endoscopic finding)
436 (68.7%)
Positive urease test (Helicobacter pylori)
111 (18.6%)
Hiatal insufficiency or hernia (endoscopic)
207 (32.5%)
Esophagitis (endoscopic)
139 (21.9%)
Esophagitis in patients post-LSG
8 (23.5% of 34)
Key Findings
Gastritis was the most common abnormality, present in 68.7% of patients.
Hiatal insufficiency or hiatal hernia was detected endoscopically in 32.5% of patients and intraoperatively in 15.1%, with all hernias repaired during surgery.
Esophagitis was found in 21.9% of patients, including 23.5% of those who had previously undergone sleeve gastrectomy.
Helicobacter pylori infection was identified in 18.6% of patients and treated preoperatively.
5.3% of sleeve gastrectomy cases were converted to other bariatric procedures, mainly due to GERD or weight regain.
Endoscopic findings influenced perioperative or operative strategy changes in a subset of patients.
Clinical Implications
Routine preoperative upper-GI endoscopy in bariatric patients can identify common pathologies such as gastritis, hiatal hernia, and esophagitis that may impact surgical planning. Detection and treatment of Helicobacter pylori infection preoperatively may reduce postoperative complications. Identifying hiatal hernias allows for concurrent repair during bariatric surgery, potentially improving outcomes. These findings support consideration of routine endoscopy, especially in patients with GERD symptoms or prior bariatric procedures.
Conclusion
Preoperative upper-GI endoscopy reveals a high prevalence of clinically relevant abnormalities in bariatric patients, which can influence surgical decision-making and postoperative management. Its use should be considered an integral part of the bariatric surgery workup to optimize patient outcomes.
References
German Guidelines 2019 -- Recommendation for routine upper-GI endoscopy in bariatric patients
ASMBS Guidelines 2018 -- Individualized indication for upper-GI endoscopy
Savary-Miller Classification 1982 -- Esophagitis grading system
Updated Sydney System 1996 -- Gastritis classification
Study Authors 2024 -- The Necessity of Preoperative Upper-GI Endoscopy in Bariatric Surgery
by Yusef Moulla, Orestis Lyros, Matthias Mehdorn, Undine Lange, Haitham Hamade, Rene Thieme, Albrecht Hoffmeister, Jürgen Feisthammel, Matthias Blüher, Boris Jansen-Winkeln, Ines Gockel, Arne Dietrich
