Endoscopic Assessment Prior to Bariatric Surgery in Saudi Arabia

Abstract

Background: There are marked local inconsistencies in the Arabian Peninsula about the role of preoperative esophagogastroduodenoscopy (EGD) in bariatric surgery. Thus, this study was conducted to determine the frequency of endoscopic and histological findings in the Saudi population presenting for pre-bariatric surgery evaluation.

Material and methods: This was a retrospective study that included all the patients who were evaluated by EGD at Dammam Medical Complex, Dammam, Saudi Arabia, between 2018 and 2021 as a part of their pre-bariatric-surgery evaluation.

Results: A total of 684 patients were included. They consisted of 250 male and 434 female patients (36.5% and 63.5%, respectively). The mean ± standard deviation for the patients' age and body mass index (BMI) were 36.4±10.6 years and 44.6±5.1 kg/m², respectively. Significant endoscopic or histopathological findings as defined by the presence of large (≥ 2 cm) hiatus hernia, esophagitis, gastroesophageal reflux disease (GERD), Barrett esophagus, gastric ulcer, duodenal ulcer, or intestinal metaplasia were found in 143 patients (20.9%); 364 patients (53.2%) were diagnosed to have Helicobacter pylori infection.

Conclusion: The high number of significant endoscopic and histopathological findings in our study supports the routine use of preoperative EGD in all bariatric surgery patients. However, omitting EGD before Roux-en-Y gastric bypass (RYGB) in asymptomatic patients is still reasonable as the most frequently found significant findings, esophagitis, and hiatus hernia, are less likely to impact the operative plans in RYGB. Similarly, active surveillance and treatment of H. pylori infections in obese patients are important but it is not clear whether H. pylori eradication should be done before bariatric surgery.

Keywords: bariatric surgery; esophagogastroduodenoscopy; helicobacter pylori; obesity; preoperative evaluation.

Figure 1. Flowchart for the reviewed patients

Figure 2. Patients' sex (n = 684)

Figure 3. Patients' obesity class (n = 633)

Most of the studied patients were of the third World Health Organization (WHO) obesity class as defined by a body mass index (BMI) of ≥40 kg/m² (585 patients, 88.2%). Most of them also had at least one obesity-related comorbid condition (409 patients, 61.2%).  Examples of these conditions include type 2 diabetes mellitus, hypertension, hyperlipidemia, nonalcoholic fatty liver disease, gastroesophageal reflux disease, debilitating osteoarthritis, and obstructive sleep apnea. The BMI was not recorded for 21 patients.

Figure 4. Helicobacter pylori infection (n = 684)

Three hundred and sixty-four patients (53%) were diagnosed to have H. pylori infections based on a histopathological assessment of their biopsies. No biopsy report was found in 39 patients (6%). H. pylori: Helicobacter pylori

Figure 5. Patients' endoscopic and histological findings (n= 684)

Significant endoscopic or histopathological findings (excluding H. pylori infections) as defined by the presence of large (≥ 2 cm) hiatus hernia, esophagitis, GERD, Barrett's esophagus, gastric ulcer, duodenal ulcer, or intestinal metaplasia were found in 143 patients (21%).