Usefulness of Upper Endoscopy for Pre-bariatric Surgery Clearance: A Look at a Predominantly Minority Population

Abstract

Introduction: Obesity has reached epidemic proportions in the US. More than third the U.S population is estimated to have a BMI of > 30. As per CDC, the prevalence of obesity is highest in African Americans. The annual medical cost of obesity in the U.S. was estimated at $147 billion in 2008 U.S. dollars. In recent years, bariatric surgery is garnering increasing attention as a modality of weight reduction. From 1994 to 2005, there was a tenfold increase in the number of bariatric surgeries performed in the United States and it is expected to be one of the most common procedures in the next twenty years. Many physicians perform pre-operative esophagogastroduodenoscopy (EGD) before performing a bariatric surgery. Finding significant pathology on endoscopy could potentially alter the course of management and the patient's eligibility for bariatric surgery. However, due to a lack of studies the true efficacy of performing an endoscopy in this case remains unknown. Methods: In this retrospective study, we reviewed all upper endoscopies done for pre-operative evaluation of bariatric surgery over a period of two years from December 2012 to December 2014. Outcome data of endoscopic and pathological finding were analyzed. Results: 119 patients were included in the study. The average age was 39 years. 86.5% were female. 54.6% were African Americans and 13.4% were Hispanics. The average BMI was 48.7, 48.2 and 47.2 in the total population, African Americans and Hispanics respectively. Chronic gastritis was the most common finding on pathology (74.7% total study population, 76.9% African Americans and 68.7% Hispanics). 42.8% of total study population had reactive gastropathy which was more common in African Americans than in Hispanics (46.1% Vs 25 %). H. pylori was more common in Hispanics than African Americans (43.7% vs 35.3% respectively). Hiatus hernia was present in 28.5% of total population, 46.1% of African Americans and 18.7% of Hispanics. 10.9% of total population had gastric ulcers. All ulcers were superficial, white based and non-bleeding. 50% of the gastric ulcers had positive H. pylori. Intestinal metaplasia was found in 4.2 % of population. There was no significant difference in endoscopic and pathological finding in patients with BMI < 40 vs. 40-50 vs. > 50. Conclusion: This study appears to indicate an important role for upper endoscopy prior to bariatric surgery particularly in a minority population.