Prevalence Of Endoscopic Findings Research Articles

Impact of preoperative esophagogastroduodenoscopy in patients undergoing bariatric surgery and development of a model to predict clinically significant abnormal endoscopic findings.

BackgroundPreoperative esophagogastroduodenoscopy (EGD) in patients undergoing bariatric surgery can help surgeons detect abnormalities in the upper gastrointestinal (UGI) tract that may require a change in surgical plan. However, the need for EGD before bariatric surgery is controversial.ObjectivesWe aimed to determine the prevalence of UGI abnormalities and evaluate the predictive factors of abnormal findings that require a change in surgical plan or cause a delay in surgical treatment in patients undergoing bariatric surgery and develop a prediction model.MethodsThe medical records from January 2012 to July 2020 were retrospectively reviewed in patients who underwent EGD before bariatric surgery. The EGD findings were classified into four groups based on their effects on management. Group 1 had normal findings. Group 2 had abnormal findings that did not require a change in surgical management. Group 3 had abnormal findings that required a change in the surgical plan or caused a delay in surgical treatment. Group 4 had contraindications to surgery. Predictive factors for Groups 3 and 4 were analyzed using univariate and multivariate analyses. A model visualized as a nomogram was developed based on significant factors. Discrimination and calibration were evaluated.ResultsA total of 461 patient records (63.8% female) were reviewed. The mean age was 35.1 ± 11.2 years and the mean BMI was 47.7 ± 8.7 kg/m2. The prevalence of endoscopic findings in Groups 1, 2, 3, and 4 were 42.5%, 35.6%, 21.9%, and 0%, respectively. The most common abnormal findings were non-erosive gastritis (31.2%) followed by Helicobacter pylori infection (18.7%) and hiatal hernia (10.2%). Male sex and NSAID use were significantly associated with detection of lesions in Group 3 either on univariate or multivariate analysis, while type 2 diabetes mellitus (T2DM) was a significant protective factor on multivariate analysis. On subgroup analysis in patients ≥ 40 years old, multivariate analysis revealed age, BMI, and NSAID use were significantly associated with the detection of lesions in Group 3, while T2DM was still a significant protective factor. A nomogram to predict lesions in Group 3 for this subgroup was developed and showed good discrimination (C-statistics 0.737, 95% CI 0.721‒0.752).ConclusionA high prevalence of abnormal endoscopic findings was observed in Thai patients who are undergoing bariatric surgery. Preoperative EGD screening is helpful in detecting UGI abnormalities that require a change in the surgical decision plan. The new nomogram may help rational utilization of EGD prior to bariatric surgery.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s00464-022-09391-8.

Prevalence of Endoscopic Findings Before Bariatric Surgery and Their Influence on the Selection of the Surgical Technique.

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most popular procedures performed. The decision of which technique is most appropriate depends on the surgeon's preferences and experience. However, several factors strongly influence the decision of the procedure performed, including gastrointestinal disorders or asymptomatic upper gastrointestinal endoscopy (UGE) findings. This study aimed to describe the pathological endoscopic findings in morbidly obese patients undergoing preoperative routine UGE. A retrospective review of a prospectively collected database of all UGEs performed before bariatric surgery was performed. UGE was routinely performed to all the patients as part of the preoperative evaluation protocol. A total of 790 patients were included. Surgical technique included 610 (77.2%) RYGB and 180 (22.8%) SG. Twenty-one asymptomatic patients presented esophagitis at UGE. In only seven patients (0.89%), the endoscopic findings of esophagitis had changed the initial surgical decision. The presence of ulcers or adenomatous or incompletely resected polyps was an indication for SG, to assure future endoscopic access in case it is needed. In 25 patients (3.17%), the initial operation would have been changed based on UGE findings. Preoperative UGE allows the diagnosis of asymptomatic esophagitis related to gastroesophageal reflux disease and the identification of asymptomatic polyps and ulcers, with the potential ability for malignant transformation. In up to 3.17% of the cases, the endoscopic findings changed the operative strategy. As the complication rate associated with the procedure is low, we recommend the routine performance of preoperative UGE before bariatric surgery.

Diagnostic yield of gastrointestinal endoscopy in North West Region Cameroon and trends in diagnosis over time.

IntroductionGastrointestinal endoscopy is an important modality for diagnosis and treatment of gastrointestinal disease, but there are limited data regarding the diagnostic yield of endoscopy in Cameroon and changes in the prevalence of endoscopic findings over time. Our aims were to describe the diagnostic utility of esophagogastroduodenoscopy (EGD) and colonoscopy, the impact of periodic on-site mentorship on cecal intubation rate and changes in the prevalence of common upper gastrointestinal findings when compared to a similar report from our region published in 1990.MethodsRetrospective review of all EGD and colonoscopy procedures performed during 2015 at a regional referral hospital in North West Region, Cameroon, with comparison to EGD findings reported by Dent and colleagues in 1990. During the year 3 endoscopists provided periodic colonoscopy mentorship.ResultsAmong 1,371 EGDs, abnormalities were found in 59.7% and therapeutic interventions (most commonly esophageal stricture dilation or band ligation of varices) were performed in 137 (10%). When compared to 25 years previously, peptic ulcer disease was less common and esophagitis was more common (p < 0.0001; p < 0.0001). The prevalence of malignancy (2.2%) was similar. Among 380 colonoscopies diagnostic findings were seen in 60.5%, including colorectal malignancies in 5.8%. Cecal intubation rate improved from 32% to 89% during the one-year study period.ConclusionEGD and colonoscopy have a diagnostic yield of about 60% in symptomatic patients in North West Region, Cameroon. When compared to 1990 peptic ulcer disease was less common and esophagitis was more common. Periodic on-site mentorship was associated with improved physician performance of colonoscopy.

Value of Preoperative Esophagogastroduodenoscopy in Morbidly Obese Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass

Background : Roux-en-Y gastric bypass hinders post-operative endoscopic evaluation of the upper gastrointestinal tract. Our aims were to determine the prevalence of preoperative endoscopic findings in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) and to determine the proportion of patients in which these findings changed surgical management.Methods : We retrospectively evaluated electronic medical records of patients undergoing esophagogastroduodenoscopy (EGD) with routine antral biopsy for Helicobacter pylori (HP) detection, prior to LRYGB between January 2003 and January 2010 at our institution. The prevalence of all endoscopic findings was determined.Results : 652 underwent preoperative endoscopy prior to LRYGB. The mean age was 39.5 ± 11.3 years and mean body mass index was 42.8 ± 5.0 kg/m2. Abnormalities were found in 444 patients (68.1%). Findings at EGD were hiatal hernia 24.3% (n = 159), esophagitis 30.8% (n = 201), Barrett’s esophagus 0.8% (n = 5), gastritis 36.2% (n = 236), gastric or duodenal ulcers 7.5% (n = 49) and 2 cases of gastric cancer. The prevalence of HP infection was 17.6% (n = 115). In 51 patients (7.8%), endoscopic findings led to postponement of surgery: in 49 patients, gastric or duodenal ulcer had to be treated prior to surgery, in 2 patients, gastric cancer led to changement in surgical approach.Conclusions : Routine preoperative EGD detects different abnormalities which need a specific approach prior to bariatric surgery. EGD with routine biopsies for HP detection should be included in the preoperative workup prior to LRYGB. Positive EGD findings led to a change in medical treatment in a quarter (24.3%) of patients. Postponement of surgery due to the EGD findings was less frequent (7.8%).

Su1133 A Meta-Analysis of the Diagnostic Utility of the Endoscopic Features of Eosinophilic Esophagitis

vasculature 41%; endoscopy was normal in 17% (see Table). Rings and strictures were more prevalent in adults (57% and 25%, respectively) than in children <18 years of age (11% and 8%; p<0.05), while white plaques and pallor/decreased vasculature were more prevalent in children (36% and 58%) than in adults (19% and 18%; p<0.05; see Table). Prospective studies reported a greater prevalence of at least one endoscopic finding than retrospective studies (93% vs 80%; p<0.05). No differences according to study size were observed. The initially observed heterogeneity (I2 from 87-98%) was decreased after the stratified analysis. Conclusions: This meta-analysis demonstrated substantial heterogeneity in the prevalence of endoscopic findings in EoE, and the pooled prevalence varied by patient age and study design. While the prevalence of any one individual feature might be low, 83% of individuals reported in the literature have at least one finding on endoscopy, increasing to 93% when considering just prospective studies. Pooled prevalence of endoscopic findings in patients with EoE

Indications, Diagnostic Findings, and Completion Rate of Small Bowel Capsule Endoscopy: A Single Center Experience

Purpose: To report our experience with small bowel capsule endoscopy (SCE) performed over the past 7½ years. Methods: We retrospectively reviewed 882 SCE cases (January 2003-May 2010) that were performed for evaluation of obscure gastrointestinal bleeding (OGIB), suspected Crohn's disease (17.3%), suspected small bowel tumor (5.4%), abnormal radiological findings (1.7%), chronic unexplained abdominal pain (1.36%), chronic diarrhea (1.6%), and others (3.3%). See Table 1. All SCE cases were reviewed by one trained SCE technician and three experienced gastroenterologists/capsule endoscopists (> 500 SCE cases). Demographic data, indications for referral, endoscopic findings, diagnostic yield, and the number of incomplete studies were evaluated using frequency tables, cross tabulations, and Pearson Chi-square tests.Table 1: Indications and age group distributionResults: See Table 2: The most common SCE findings were angiodysplasia (56.8%), ulcer/erosion (32.5%), lymphangiectasia (26%), and mass lesion (20.9%). In the subgroup analyses, the age group of older than 50 years old had significantly higher prevalence of angiodysplasia (63% vs. 50%, p < 0.05) and lymphangiectasia (34.2% vs. 18.2%, p <0.05) than in younger population. There were 127 cases (14.3%) of incomplete SCE studies defined as the capsules did not enter the cecum (n=101, 79.5%) or did not leave the stomach (n=26, 20.5%). No complications of acute bowel obstruction or perforation occurred in this series.Table 2: Prevalence of endoscopic findings by age groupConclusion: SCE is a safe & useful diagnostic tool for detecting small bowel pathology including OGIB, suspected Crohn's disease, and small bowel tumor. Angiodysplasia is the most common SCE finding and is more common in patients over the age of 50.

Predictors of specialized intestinal metaplasia in patients with an incidental irregular Z line

Barrett's esophagus is a well-known complication of gastroesophageal reflux disease (GERD) and is associated with dysplasia and esophageal adenocarcinoma. Data on the prevalence of specialized intestinal metaplasia (SIM) in biopsy taken from an incidental irregular Z line are scarce. To determine the prevalence of SIM in biopsies taken from an incidental irregular Z line in consecutive patients undergoing upper endoscopy. During the study period, we identified all adult patients who underwent an upper endoscopy with biopsies from an incidental finding of an irregular Z line. Demographic characteristics, prevalence of endoscopic findings, and major complaints were compared between those with SIM and those without. A total of 166 out of 2000 (8.3%) consecutive patients were identified. Specialized intestinal metaplasia was found in 43.5% of all cases. Male sex and the presence of hiatus hernia were predictors of SIM (P=0.043 and 0.001, respectively), with relative risks of 2.02 (95% confidence interval: 1.01-4.0) and 3.31 (95% confidence interval: 1.66-6.58), respectively. In this endoscopic and histological study, SIM was found to be a common finding in patients with irregular Z line. Male sex and the presence of diaphragmatic hernia were significantly associated with the presence of SIM.

Colonoscopic Findings in Outpatients with Rectal Bleeding

Introduction: Intermittent scant hematochezia is a common pattern of lower GI bleeding encountered in primary care. Two recent prospective trials, 1, 2 yielded conflicting results regarding the association with rectal bleeding and the finding of colorectal neoplasia. The aim of this study was to evaluate the endoscopic findings in a population of patients from the Omaha VA medical center (OVAMC), with hematochezia, referred from their primary care provider for colonoscopy. Methods: We analyzed all colonoscopies performed at the OVAMC, for the indication of hematochezia, from December 2000, through December 2005. We evaluated patient demographics, the presence of preoperative anemia or weight loss, endoscopic findings and relevant pathology. Results: 437 colonoscopies were performed for hematochezia between December 2000 and December 2005. The mean age was 59 years. There were 415 males and 22 females. The prevalence of colorectal neoplasia was 33.4% (adenocarcinoma 6.6%, adenomas 23.6%, villous adenomas 3.2%). Non-neoplastic polyps were found in 19%, while 14% of colonoscopies were normal. Overall 14% of patients with any neoplasia were anemic. Of those patients diagnosed with adenocarcinoma, 31% were anemic. Weight loss in the year preceding colonoscopy was documented in 39% of all patients. Of those patients diagnosed with adenocarcinoma 62% had weight loss in the preceding year. Weight loss of 10 pounds or more occurred in 9% overall, and in 21% of patients with adenocarcinoma. 93% of the adenocarcinomas were detected in the sigmoid or rectum, while 7% were found proximally (ascending colon or cecum). Of all adenomas and villous adenomas, 27% were <5 mm in size; 45% were 5 to 9 mm and 27% were ≥10 mm in size. 79% of all polyps with villous histology were ≥10 mm in size, 21% were 5 to 9 mm and there were no villous adenomas <5 mm in size. Conclusion: There is no standardized approach to the evaluation of lower GI bleeding. Estimates vary regarding the prevalence of endoscopic findings in patients with scant intermittent hematochezia, including neoplasia. Adenocarcinoma was surprisingly prevalent in our population. A high proportion of these patients had other easily identifiable signs and symptoms such as weight loss or anemia. Simple clinical tools may be helpful to identify patients at higher risk for colorectal neoplasia.

Prevalence of Upper Gastrointestinal Tract Findings in Patients With Noncardiac Chest Pain Versus Those With Gastroesophageal Reflux Disease (GERD)-Related Symptoms: Results from a National Endoscopic Database

Available data on the prevalence of esophageal and upper gut findings in patients with noncardiac chest pain (NCCP) are scarce and limited to one center's experience. To determine the prevalence of esophageal and upper gut mucosal findings in patients undergoing upper endoscopy for NCCP only versus those with gastroesophageal reflux disease (GERD) symptoms only, using the national Clinical Outcomes Research Initiative (CORI) database. During the study period, the CORI database received endoscopic reports from a network of 76 community, university, and Veteran Administration Health Care System (VAHCS)/military practice sites. All adult patients who underwent an upper endoscopy for NCCP only or GERD-related symptoms only were identified. Demographic characteristics and prevalence of endoscopic findings were compared between the two groups. A total of 3,688 consecutive patients undergoing an upper endoscopy for NCCP and 32,981 for GERD were identified. Normal upper endoscopy was noted in 44.1% of NCCP patients versus 38.8% of those with GERD (P<0.0001). Of the NCCP group, 28.6% had a hiatal hernia (HH), 19.4% erosive esophagitis (EE), 4.4% Barrett's esophagus (BE), and 3.6% stricture/stenosis. However, HH, EE, and BE were significantly more common in the GERD group as compared with the NCCP group (44.8%, 27.8%, and 9.1%, respectively, P<0.0001). In univariate analysis of patients with NCCP, male gender was a risk factor for BE (OR 1.86, 95% CI 1.35-2.55, P=0.0001) and being nonwhite was protective (OR 0.43, 95% CI 0.22-0.86, P=0.02). In this group, male gender was also a risk factor for EE (OR 1.31, 95% CI 1.11-1.54, P=0.001) and age>or=65 yr was protective (OR 0.73, 95% CI 0.6-0.89, P=0.002). The NCCP group had a significantly higher prevalence of peptic ulcer in the upper gastrointestinal tract as compared with the GERD group (2.0% vs 1.5%, P=0.01). In this endoscopic prevalence study, most of the endoscopic findings in NCCP were GERD related, but less common as compared with GERD patients.

Endoscopy Plays an Important Preoperative Role in Bariatric Surgery

The role of upper endoscopy (EGD) in obese patients prior to bariatric surgery is controversial. The aim of this study was to evaluate the diagnostic yield and cost of routine EGD before bariatric surgery. The medical records of consecutive obese patients who underwent EGD prior to bariatric surgery between May 2000 and September 2002 were reviewed. Two experienced endoscopists reviewed all EGD reports, and findings were divided into 4 groups based on predetermined criteria: group 0 (normal study), group 1 (abnormal findings that neither changed the surgical approach nor postponed surgery), group 2 (abnormal findings that changed the surgical approach or postponed surgery), and group 3 (results that were an absolute contraindication to surgery). Clinically important findings included lesions in groups 2 and 3. The cost of EGD (430.72 US dollars) was estimated using the endoscopist fee under Medicare reimbursement. During the 28-month study period, 195 patients were evaluated by EGD prior to bariatric surgery. One or more lesions were identified in 89.7% of patients, with 61.5% having a clinically important finding. The prevalence of endoscopic findings using the classification system above was as follows: group 0 (10.3%), group 1 (28.2%), group 2 (61.5%), and group 3 (0.0%). Overall, the most common lesions identified were hiatal hernia (40.0%), gastritis (28.7%), esophagitis (9.2%), gastric ulcer (3.6%), Barrett's esophagus (3.1%), and esophageal ulcer (3.1%). The cost of performing routine endoscopy on all patients prior to bariatric surgery was 699.92 US dollars per clinically important lesion detected. Routine upper endoscopy before bariatric surgery has a high diagnostic yield and has a low cost per clinically important lesion detected.

The Prevalence of Erosive Esophagitis in Children: A Population-based Study

The Prevalence of Erosive Esophagitis in Children: A Populationbased Study Mark A. Gilger, Hashem B. El-Serag, Craig L. Dietrich Symptoms of gastroesophageal reflux disease (GERD) occur in 2-7% of children. The manifestations of GERD can be limited to symptoms (e.g. heartburn, regurgitation) or can be more complicated, such as erosive esophagitis (EE), esophageal strictures or Barrett’s esophagus. The prevalence of such GERD complications in children is unknown. PURPOSE: To determine the prevalence of endoscopic findings of EE in children.METHODS: All children aged 0 to 18 years who underwent EGD that was recorded in the Pediatric Endoscopic Database System Clinical Outcomes Research Initiative (PEDS-CORI) between 1999 and 2002 were included. Endoscopic reports that were incomplete, missing demographic features, indications for endoscopy or endoscopic findings were excluded. EE was defined either descriptively (erythema, erosion, ulcer) or by Los Angeles classification. Esophageal biopsy was not evaluated. RESULTS: 8038 children who underwent EGD fulfilled the inclusion and exclusion criteria. Of those, 1070 (13.3%) had EE. The mean age of children with children with EE was 12.6 (+/ 5.6) yrs vs. 10.0 (+/ 6.0) yrs in those without EE (p=<0.0001). There were 575 (53.7%) males with EE as compared with 3315 (46.7%) in those without EE (p=.0002). EE was found in 106 (9.9%) children aged 0-2 years, 73 (6.8%) children aged 3-5 years, 277 (25.9%) children aged 6-12 years, and 432 (40.4%) children aged 13-17 years. Hiatal hernia was found in 108 (10.1%) of children with EE, compared to 228 (3.2%) in those without EE (p=<0.0001). Mucosal abnormalities were identified in 390 (36.4%) of children with EE vs. 1327 (19.0%) of those without EE (p=<0.0001). The prevalence of Barrett’s esophagus, esophageal stricture, ulcer, prior surgery, nodules, foreign body/retained food and anatomical abnormalities were not significantly different between children with EE and those without. CONCLUSIONS: The prevalence of erosive esophagitis is slightly higher inmales and increases with age. In contrast to erosive esophagitis in adults, there were no significant variations according to race or ethnicity. Hiatal hernia is the only clinical observation that predicts the presence of EE. **470 The Presence of Helicobacter pylori in the Intestinal Mucosa is Closely Associated with Ulcerative Colitis Like Crohn’s Disease (UCLCD) Phenotype Dulciene M.M. Queiroz, Adriana G. Oliveira, Maria das Gracas P. Sanna, Andreia M.C. Rocha, Gifone A. Rocha Sr., Silvia B. Moura, Renato Dani, Maria de Lourdes A. Ferrari, Frederico P. Marinho, Liano S. Moreira, Lucia P.F. Castro Crohn’’s disease (CD) is a heterogeneous disorder with diverse clinical manifestations. Recently, fibrostenosing CD was associated with a serologic response to gut microbiota such as Pseudomonas fluorescens, ASCA and mutated allele of NOD2. We investigated whether the presence of Helicobacter in the intestinal mucosa was associated with specific disease phenotypes. We studied 117 patients: 74 controls and 43 with CD (22 with fibrostenosing, 16 with perforating and 12 UCLD). Fragments from the ileum and 6 different colon regions were obtained at colonoscopy. Helicobacter was investigated by culture, Helicobacter 16S rRNA, ureAnested PCR and characterized by 16S rRNA sequencing. Gastric HP infection was diagnosed by C-UBT and serology. Seven HP strains were isolated from the intestinal mucosa of 1 (2.2%) control and 6 (14.0%) CD patients (1with perforating and 5withUCLD) (p=0.02). SpecificHPDNAwas detected in the intestinal biopsies of 7 (9.5%) controls and 17 (39.5%) CD patients (p=0.0003).No otherHelicobacter species was identified.HPwasmore frequently isolated (47.1%v3.2%, p=0.004) or detected by PCR (58.3%v 22.6%, p=0.03) in the intestinal mucosa of patients with UCLD. If we considered only the group of gastric HP-positive patients, PCR was positive in 18.4% of the controls and in 100% of UCLD CD patients (p=0.00007). The positive results of culture (0.0% v 28.6%, p=0.009) and PCR (18.2% v 47.6%, p=0.04) were negatively associated with fibrostenosing disease. Positive culture was also inversely associated with ileal localization of CD (p=0.006). No association was seen between fistulating disease and positive culture (6.3% v 18.5%, p=0.4) and PCR (25.0%v 37.0%, p=0.4). Positive culture and PCRdid not associate with diarrhea in any subgroup. Gastric HP infection was similar in control (38-51.4%) and CD (21-48.7%) patients (p=1.0). However, the mean IgG titer against HP was lower (p=0.006) in CD patients (51.0U/ml) than in controls (239.7 U/ml). Furthermore, a significant difference was seen (p=0.04) between UCLD (103.8U/ml) and stenosing disease (24.5U/ml). We demonstrated associations between CD clinical phenotypes and the presence of viable HP or HP DNA in the intestinal mucosa that may indicate an abnormal higher number of HP in the intestinal mucosa or HP intestinal colonization in UCLD patients. Humoral immune response to HP infection was also influenced by CD phenotype, with a low reactivity to HP infection in stenosing disease phenotype.

Prevalence of endoscopic findings in 510 consecutive individuals with cirrhosis evaluated prospectively

Upper gastrointestinal hemorrhage is one of the more important complications of cirrhosis and a major cause of death in such patients. The main sites of bleeding are esophageal varices, gastritis, and peptic ulcers. In order to determine the prevalence of either potential bleeding lesions or of other endoscopic findings in hemodynamically stable individuals with various etiologies of cirrhosis, 510 consecutive cirrhotic patients, evaluated for possible orthotopic liver transplantation (OLTx) underwent an upper gastrointestinal endoscopy for combined diagnostic and therapeutic purposes. The patients were divided into two main groups: 319 patients with parenchymal liver disease and 191 patients with cholestatic liver disease. Gastritis was found significantly more often in patients with parenchymal liver disease than in those with cholestatic liver disease (49.8% vs 30.9%; P less than 0.001). In contrast, the prevalence of esophagitis, esophageal and gastric varices, gastric ulcer, duodenal ulcer, and duodenitis was similar in both groups. Normal endoscopic findings were present in 5.0% of the parenchymal group and 11.5% of the cholestatic group (P less than 0.02). Ascites and encephalopathy were found significantly more often in subjects with parenchymal liver disease as compared to those with cholestatic liver disease. Portal hypertension and its degree, as assessed by the presence and size of esophageal varices, was similar in both groups, and in both groups there was a statistically significant qualitative trend of increasing prevalence of esophageal varices with increasing severity of disease as estimated using Pugh-Child's criteria.