Is Routine Preoperative Upper Endoscopy in Gastric Banding Patients Really Necessary?

Abstract

The data suggest that it may not be necessary to continue performing gastroscopy in all patients preparing for gastric banding. The data collected support the policy of a selective use of gastroscopy, only focusing on patients suffering from gastroesophageal symptoms. By following this strategy, the rate of preoperative gastroscopies can be reduced safely by 80%.

Preoperative Endoscopic Screening for Laparoscopic Roux-en-Y Gastric Bypass has a Low Yield for Anatomic Findings

“…Increasing BMI is positively correlated with vomiting, upper abdominal pain, and constipation, thus supporting a more selective approach to screening based on UGI symptoms [23]. Moreover, Korenkov et al suggest that an 80% reduction in the rate of preoperative EGD can be achieved by limiting this procedure to patients who have UGI symptoms [13]. The overall prevalence of findings in all their patients was only 10%, but symptomatic patients had a significantly higher yield of findings (67%) at EGD compared to patients without symptoms who had an extremely low yield (2%).…”

“…Additional sedation issues for the morbidly obese include postprocedure nausea and vomiting, which can be lessened with anesthesiologist-administered propofol as compared to endoscopist-administered benzodiazepines [8]. Prior studies in the literature have suggested that significant findings are detected in approximately one third of patients undergoing preoperative EGD [9][10][11][12][13][14].…”

Carcinoid Tumors and Morbid Obesity

“…Chromogranin A has been described as a biochemical marker in patients with gastric carcinoids, used for disease diagnosis and monitoring [3,13,16]. Many articles have described upper endoscopy as an important tool in bariatric surgery [21][22][23][24][25][26]. After surgery, the gastric remnant becomes inaccessible to conventional endoscopic examinations, denoting the importance of the endoscopic procedure before bariatric surgery.…”

Swedish adjustable gastric banding – an underestimated risk factor for the development of esophageal cancer?

“…Nevertheless, the indication for the implantation of the SAGB was correct since a protective effect of SAGB for GERD has been advocated years ago provided a normal esophageal peristalsis [8]. A preoperative evaluation of the gastroesophageal junction is still under debate and until presently no generally accepted approach is defined [8,[11][12][13].…”