Should endoscopy be routinely performed for bariatric surgery candidates?

Abstract

Objectives. The rationale for a routine endoscopy before bariatric surgery in asymptomatic patients remains controversial. The purpose of the present study was to compare, in a retrospective manner, the endoscopic findings of morbidly obese patients awaiting surgery with those of non-obese individuals. Methods. Between January 2014 and December 2014, preoperative endoscopic findings of 161 morbidly obese patients and 101 consecutive non-obese individuals were evaluated. Results. No significant differences were found between the two groups in terms of ulcer prevalence and the number of ulcers (p=0.120 and p=0.122, respectively). However, the frequency of bulbar ulcers was significantly higher in morbidly obese patients than in the non-obese (p=0.012). Furthermore, the ulcer activity score was significantly higher in morbidly obese patients (p=0.025). 84 patients underwent laparoscopic sleeve gastrectomy (LSG). Of those, 48 patients (57.1%) had Helicobacter pylori sero-positivity and 12 patients (14.3%) had peptic ulcer disease before surgery. H. pylori sero-positivity persisted in the resected gastric specimens of 33 patients (39.3%). Conclusion. The ulcer activation score in morbidly obese patients is higher -even when they are asymptomatic- than in non-obese individuals. Routine preoperative endoscopy should be considered in all bariatric surgery candidates to rule out pathologies such as hiatal hernia, extensive ulcers or malignant lesions which are the contraindications for a LSG.