Current Status of Preoperative Oesophago-Gastro-Duodenoscopy (OGD) in Bariatric NHS Units-a BOMSS Survey

Abstract

Purpose: Preoperative oesophago-gastro-duodenoscopy (p-OGD) is often routinely employed in patients undergoing bariatric surgery. The value of p-OGD is still unclear; however, since all bariatric procedures modify stomach anatomy differently with exclusion of the remnant in a majority of cases, the question arises whether there is a rational for including it routinely in the preoperative pathway.

Material and methods: To assess the current status of p-OGD in the UK, a survey was sent to the British Obesity & Metabolic Surgery Society members, regarding preoperative evaluation of patients, focusing on the role of p-OGD. Forty-nine UK bariatric units (in excess of 5000 patients estimated caseload/year) answered.

Results: The survey has shown that 44 units (90 %) include OGD in their preoperative work up, routinely or selectively. According to results, 25 units (51 %) changed the operative plans after OGD because of peptic ulcer (46 %), hiatus hernia (43 %), Barrett's oesophagus (32 %) or gastrointestinal stromal tumour (25 %). Only 2 units (7 %) found incidental gastrointestinal cancer. When specifically asked, p-OGD was believed to be essential in patients with family history of gastrointestinal cancer (61 %), pernicious anaemia (57 %) and reflux symptoms (54 %). Five units (10 %) considered p-OGD completely unnecessary. Only 11 units (25 %) would not be able to accommodate routine p-OGD in all patients.

Conclusions: Most units value p-OGD, either selectively or routinely, in preparation for bariatric surgery. However, there seems to be a discrepancy on the specific risk factors involved in the selection process. National and international guidelines are advocated.

Keywords: Bariatric surgery; Obesity; Preoperative OGD; Preoperative work up; Upper gastrointestinal endoscopy.