Preoperative EGD and Surgical Specimen Findings in Bariatric Surgery Patients

Overview

This retrospective study evaluated the role of preoperative esophagogastroduodenoscopy (EGD) in patients undergoing metabolic-bariatric surgery (MBS), focusing on the prevalence of clinically significant findings and their impact on surgical planning. Among 3718 patients, 36.9% underwent preoperative EGD, revealing notable rates of esophagitis, Barrett’s esophagus, and Helicobacter pylori infection. Surgical specimen analysis identified additional gastric pathologies, underscoring the complementary value of EGD and pathology in preoperative assessment.

Background

Metabolic-bariatric surgery, including sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), is an effective treatment for obesity. The utility of routine preoperative EGD remains debated, especially in asymptomatic patients, due to concerns about overdiagnosis and unnecessary surgical plan changes. Significant EGD findings such as hiatal hernias, reflux esophagitis, and premalignant lesions can influence surgical choice, particularly because some procedures leave a gastric remnant that is difficult to surveil. Current US guidelines recommend individualized rather than universal preoperative EGD.

Data Highlights

Key Findings

• 36.9% of patients undergoing MBS had preoperative EGD, with 56.6% performed specifically as preoperative evaluation.
• Patients undergoing preoperative EGD were older, more often Hispanic or Black, had lower BMI, and were more likely to undergo SG.
• RYGB patients had higher rates of esophagitis (22.2%) and lower rates of Barrett’s esophagus (5.91%) compared to SG patients.
• Helicobacter pylori infection was detected in 8.16% of patients on preoperative EGD; gastric intestinal metaplasia was found in 2.64%.
• Among 2349 patients with gastric surgical specimens, 135 had clinically significant gastric pathology including GIM and H. pylori infection.
• Preoperative EGD findings and surgical specimen pathology complement each other in identifying clinically relevant gastric abnormalities that may influence surgical planning.

Clinical Implications

Preoperative EGD can identify clinically significant findings such as esophagitis, Barrett’s esophagus, and H. pylori infection that may impact bariatric surgical planning and timing. Given that some gastric pathologies are only detected on surgical specimens, combining preoperative EGD with pathological assessment enhances detection of premalignant conditions. An individualized approach to preoperative EGD, considering patient demographics and clinical risk factors, is advisable to optimize surgical outcomes.

Conclusion

Preoperative EGD reveals important endoscopic findings in a substantial subset of bariatric surgery patients, while surgical specimen pathology uncovers additional gastric abnormalities. Together, these assessments inform surgical decision-making and highlight the value of tailored preoperative evaluation strategies.

References

1. ASMBS Clinical Issues Committee 2020 -- Metabolic and Bariatric Surgery
2. American Society for Gastrointestinal Endoscopy 2021 -- Guidelines on Preoperative EGD
3. Smith et al. 2019 -- Impact of Preoperative EGD on Bariatric Surgery Planning