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Endoscopy I
PMO-222 Pre-operative endoscopy in bariatric surgery patients
  1. G Bahra1,
  2. A Desai1,
  3. A Thillainayagam2,
  4. A Ahmed3
  1. 1Foundation Year Doctor, Charing Cross Hospital, London, UK
  2. 2Gastroenterology, Charing Cross Hospital, London, UK
  3. 3Bariatric Surgery, Charing Cross Hospital, London, UK

Abstract

Introduction Some authors suggest the routine use of endoscopy in patients undergoing bariatric surgery in order to detect asymptomatic hiatal hernias, oesophagitis, and gastric ulcers. Our unit uses selective endoscopy. The current study analyses the indications and findings of upper GI endoscopy in pre-operative bariatric surgery patients.

Methods A retrospective analysis of all bariatric surgery patients referred for Upper GI endoscopy at Charing Cross Hospital from 1 January 2009 to 30 October 2011. During this time period, 1093 bariatric surgery cases were performed. These consisted of 542 laparoscopic gastric bypasses, 220 laparoscopic gastric band insertions, 223 laparoscopic sleeve gastrectomies and 108 revisional bariatric procedures. The Endoscopy units' electronic database of oesophagogastroduodenoscopies (OGDs) performed in that time period was analysed to determine how many bariatric surgery patients underwent OGDs pre-operatively and for what indication and with what result. Further sub-analysis was performed for each operation type.

Results 147 OGDs were done on a total of 116 bariatric surgical patients, with 23 patients having had more than one OGD each. Of these 147 OGDs 44 were pre-operative. 13 (29.5%) OGD referrals were made to investigate anaemia, 12 (27.3%) for pre-surgical screening to investigate existing symptoms of gastric ulceration, and 9 (20.5%) to investigate abdominal pain. The remaining referrals were made for interventional gastric balloon insertions and removals (6=13.6%) and to investigate symptoms of reflux (3=6.8%) and dysphagia (1=2.3%). The majority of patients (50%) were referred prior to having a roux-en-y gastric bypass operation. Most of the pre-operative OGD findings were normal (16=36.4%), but gastritis (6=13.6%), hiatal hernias (6=13.6%), gastric ulceration (2=4.5%), oesophagitis (1=2.3%) and duodenitis (1=2.3%) were noted. Of the 13 patients referred with anaemia, 9 (69.2%) had normal mucosa on OGD, but of the 12 patients who had pre-surgical screening 7 (58.3%) were found to have abnormalities, including a fundic gland polyp and antral erosions.

Conclusion Using a selective referral process, only 4% of all bariatric surgery cases performed required preoperative endoscopy. The commonest indication for OGD preoperatively was anaemia and the commonest pathology found was mucosal inflammation (gastritis, oesophagitis and duodenitis).

Competing interests None declared.

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