Role of esophagogastroduodenoscopy as a preoperative assessment tool in laparoscopic sleeve gastrectomy for patients with morbid obesity

Abstract

Introduction Incidence of gastroesophageal reflux disease (GERD) in patients with morbid obesity may reach up to 50%. In some centers, esophagogastroduodenoscopy (EGD) is performed routinely in the preoperative workup before bariatric surgery. However, it is still unclear what the optimal preoperative assessment is. Patients and methods This is a prospective descriptive cohort study that included 65 laparoscopic sleeve gastrectomy (LSG) patients who were evaluated preoperatively and postoperatively using a GERD questionnaire. EGD was done selectively for those high-risk patients having score more than 7 on the questionnaire. Aim The aim of this study was to evaluate the incidence of GERD in LSG patients and their outcome by using GERD questionnaire and selective EGD for patients at risk. Results Six (9.2%) patients had score more than 7 on the GERD questionnaire, and all of them had a preoperative EGD. Of 65 LSG patients, six (9.2%) patients had hiatus hernia repair, and three (50%) of these patients were discovered intraoperatively having silent hiatus hernia. There was a significant decrease in GERD in patients who underwent preoperative EGD (P=0.032). On the contrary, one (8.3%) patient developed de novo GERD and was converted to laparoscopic Roux-en-Y gastric bypass with hiatus hernia repair at 1 year. Conclusion Proper preoperative evaluation and close postoperative follow-up of LSG patients are crucial, especially in patients experiencing GERD. The GERD questionnaire and EGD are safe and effective tools and can suggest patients at risk.