Preoperative Endoscopy Prior to Bariatric Surgery: a Systematic Review and Meta-Analysis of the Literature.

Abstract

There is debate regarding preoperative endoscopy (EGD) in patients undergoing bariatric surgery. Some centers perform EGD routinely in all patients; others perform EGD selectively. The objective of this study was to perform a systematic review and meta-analysis of the existing literature to estimate how frequently preoperative EGD changes management. Our review yielded 28 studies encompassing 6616 patients. Baseline characteristics including age and body mass index (BMI) were included. Patients were grouped based on EGD findings into two groups: Group 1-findings which did not significantly change management (e.g., mild/moderate duodenitis, Grade A/B esophagitis, mild/moderate gastritis, H. pylori infection, hiatal hernia <2cm); Group 2-findings which delayed, altered, or cancelled surgery (e.g., severe duodenitis, Grade C/D esophagitis, gastric varices, hiatal hernia >2cm, mass/carcinoma). A general estimating equation (GEE) model accounting for the correlated data within each study was used to calculate confidence intervals around the estimate of how frequently surgery was delayed or altered. Mean age was 41.4 ± 2.9years, the majority was women, and mean preoperative BMI was 47 ± 3.2kg/m2. Overall 92.4% (n = 6112) had a normal EGD or findings that did not change clinical management and 7.6% (n = 504); 95% CI [4.6, 12.4%] had findings that delayed/altered surgery. The revised estimate was 20.6%; 95%CI [14.5, 28.2%] if all esophagitis (regardless of grade) were categorized into Group 2. The approximate incidence of Barrett's esophagus and carcinoma were 0.1 and 0.08%, respectively. A selective approach to preoperative EGD may be considered, based on the patients' symptoms, risk factors, and type of procedure planned.