Background

Introduction: Debate exists over whether preoperative esophagogastroduodenoscopies (EGDs) for bariatric surgery patients should be a routine screening tool in asymptomatic patients. Some studies suggest EGDs can uncover pathology that would otherwise lead to poor post-operative outcomes, while others suggest findings rarely impact surgical management. Objective: To analyze gastric specimen samples collected routinely during sleeve gastrectomy, therefore determining if routine EGD is a necessary tool in preoperative planning.

Methods

Retrospective chart review was performed on a master list of patients in our bariatric practice identified with appropriate diagnoses and procedures. Data was collected on age, gender, race, preoperative BMI and pathology results.

Results

164 gastric specimens were sent to pathology. 52% of patients had no pathology. Most common findings were vascular congestion (20%) and chronic gastritis (17%). 1% of patients had abnormal findings capable of altering surgical management, including mass lesion and helicobacter pylori, although nonsignificant (p=0.16). Preoperative EGDs were performed on 37 of these patients due to reflux symptoms. 38% had no pathology. Most common finding was chronic gastritis (27%). 2% had pathology with potential to impact management, including Barrett’s Esophagus, although nonsignificant (p=0.32).

Conclusions

Specimens were unlikely to show incidental pathology and no patients required further intervention. EGDs on symptomatic patients may find pathology in 8% of cases, although only 2% may have findings impacting choice of procedure; therefore, routine EGD is unlikely to find consequential results and, thus, should be done selectively. Further research can evaluate all bariatric preoperative EGDs to assess rate of pathology influencing surgical management.