Background
Background: Routine preoperative endoscopy for patients undergoing bariatric surgery remains controversial. However, anatomopathological findings during endoscopy can influence the choice of bariatric procedure. Gastric intestinal metaplasia (GIM) is increasingly recognized as a potential risk factor for gastric adenocarcinoma. Objective: Establish the prevalence of GIM among patients undergoing bariatric surgery in our population and determine the impact of routine esophagogastroduodenoscopy (EGD) on the choice of bariatric procedure.
Methods
We retrospectively reviewed the charts of 314 consecutive patients who underwent routine EGD with antral/corpus biopsies by a single endoscopist at our Canadian institution between March 2021 and November 2022. Data collected included patient demographics, EGD reports, and pathology reports from both endoscopy biopsies and surgical specimens.
Results
The population consisted of 234 (74.5%) females and 80 (25.5%) males with an average age of 43.6 years and BMI of 46.5 kg/m2. Overall, GIM was present in 8.4% of endoscopies, high-risk GIM in 2.2% and H. pylori in 16.6%. Esophagitis and Barrett’s esophagus were present in 19.4% and 6.4% of patients, respectively. Regression analysis did not reveal any factor significantly associated with GIM. Preoperative EGD altered the choice of the surgical procedure for 14.9% of patients, with 9.4% of changes due to hiatal anatomy/esophagitis, 2.3% due to GIM and 0.6% due to Barrett’s esophagus.
Conclusions
We demonstrated a significantly higher GIM prevalence (8.4%) than that of previously published bariatric patient cohorts. The presence of GIM is the second most frequent finding that alters the surgical decision making in our bariatric surgery population.