Routine Pre-Operative Endoscopy in Patients Undergoing Bariatric Surgery

Abstract Background The role of routine pre-operative endoscopy prior to primary weight loss surgery remains controversial. Objective We reviewed our experience to determine the frequency of abnormal findings in patients undergoing routine pre-operative endoscopy prior to bariatric surgery. Setting A tertiary level academic affiliated bariatric surgery practice. Methods A retrospective chart review was performed between July 2014 and June 2016 of patients undergoing routine pre-operative endoscopy prior to primary bariatric surgery. Variables evaluated included pre-endoscopy symptoms, planned bariatric surgical procedure, abnormal findings on endoscopy, and changes in planned bariatric surgical procedure after endoscopy. Results A total of 631 patients met inclusion criteria. 72% of patients (457) were females. The median age was 44 (IQR 36 to 55). The median body mass index (BMI) was 46 (IQR 42 to 51). Most patients had no pre-endoscopy clinical symptoms (61.3%). The most frequent abnormal findings included esophagitis (26.5%), hiatal hernia (27.1%), gastric ulcer (4.9%), and biopsy proven Barrett's esophagus (4.6%). Although patients with pre-operative symptoms were more likely to have abnormal findings on endoscopy, there were no significant differences in rates of Barrett's esophagus in patients with (5.3%) or without (4.1%) symptoms. 18.4% of the total cohort of patients had a change in their planned operation after endoscopy results. Conclusion The findings in our large series suggest that selective screening in symptomatic patients only may lead to failure of discovery of foregut pathology that should prompt consideration for changes in the planned bariatric surgical procedure. Further study is necessary to see if our findings have broad applicability.