Does digestive symptoms require esophago gastroscopy prior to bariatric procedure? Assessment of 6 years' experience
- PMID: 29629892
Does digestive symptoms require esophago gastroscopy prior to bariatric procedure? Assessment of 6 years' experience
Abstract
Aim: Performance of routine preoperative esophagogastroduodenal endoscopy (EGE) in patients undergoing bariatric surgery is still a controversial subject. The purpose of our study was to evaluate the benefits of performing preoperative EGE in a cohort of bariatric patients.
Material and methods: The present retrospective study was performed between March 2010 and June 2016. We divided the study participants into two groups: group A comprised subjects without disturbing upper digestive signs, while group B comprised patients with disturbing upper digestive signs. Logistic regression analysis was used to identify the predictors that might be associated with abnormal outcomes.
Results: Our study included 232 patients (who had undergone sleeve gastrectomy, gastric bypass, ileal interposition, or transit bipartition). The average age was 41.4 ± 10.3 years, and the average body mass index (BMI) was 43.6 ± 5.1 kg/m2. Of all the observed gastroscopic abnormalities, the prevalence for gastritis (17.3%), followed by esophagitis (10.2%), hiatus hernia (9.4%), and bulbitis (8.7%). In multivariate regression analysis, the Gastrointestinal Symptom Rating Scale (GSRS) score and upper gastric symptoms were found to be the only independent predictive markers (OR = 2.822, 95% CI: 1.674-3.456 and OR =2.735, 95% CI: 1.827-3.946, respectively). We identified a positive correlation between abnormal EGE findings and postoperative complications.
Conclusion: Preoperative EGE had a high rate of detection for the possible abnormalities prior to bariatric surgery. Upper gastric symptoms are significant predictive factors of postoperative complications. Performing preoperative EGE for symptomatic patients could help reduce the morbidity and mortality rates in these patients.
Key words: Bariatric surgery, Preoperative endoscopy, Upper digestive symptoms.
Premessa: È argomento controverso se l’esofago-gastroscopia deve precedere di regola una procedura di chirurgia bariatrica, e lo scopo di questo studio è quello di valutare i vantaggi della sua esecuzione in un gruppo di pazienti baritrici.
Metodo: Si tratta di uno studio retrospettivo effettuato tra marzo 2010 e giugno 2016, suddividendo i pazienti in due gruppi: nel gruppo A quelli senza disturbi dell’apparato digerente, e nel gruppo B quelli con sintomi riferibili all’apparato digestivo superiore. L’analisi della regressione logistica è stata utilizzata per identificare elementi che potrebbero far prevedere risultati anormali.
Risultati: Nello studio sono stati compresi 232 paziente (sottoposti a gastrectomia tubulare, bypass gastrico, interposizione dell’ileo, o bipartitione di transito). L’età media era 41,4 ± 10,3 anni e l’indice di massa corporea (BMI) è stato in media di 43,6 ± 5,1 kg / m2. Di tutte le anomalie gastroscopiche osservate, era prevalente la gastrite (17,3%), seguita da esofagite (10,2%), ernia hiatale (9,4%) e duodenite (8,7%). Nell’analisi di regressione multivariata, il punteggio della scala dei sintomi gastrointestinali (GSRS) e i sintomi dell’apparato gastrico superiori sono stati i soli indici indipendenti di previsione (OR = 2.822, 95% CI: 1.674-3.456 e OR = 2.735, 95% CI: 1.827- 3.946, rispettivamente). Abbiamo identificato una correlazione positiva tra i risultati anomali della esofagogastrocpia e le complicazioni postoperatorie.
Conclusione: L’esofagogastroscopia preoperatoria ha offerto una rilevante incidenza di rilevamento di possibili anomalie prima della chirurgia bariatrica. I sintomi dell’apparato digestivo superiore superiori sono significativi indicatori di previsione di complicanze postoperatorie. L’esecuzione di EGE preoperatorio per i pazienti sintomatici potrebbe contribuire a ridurre la morbilità e la mortalità in questi pazienti.
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