Effort, safety, and findings of routine preoperative endoscopic evaluation of morbidly obese patients undergoing bariatric surgery

• Published in: Surgical endoscopy Vol. 24; no. 8; pp. 1996 - 2001
• Main Authors: Küper, M. A., Kratt, T., Kramer, K. M., Zdichavsky, M., Schneider, J. H., Glatzle, J., Stüker, D., Königsrainer, A., Brücher, B. L. D. M.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.08.2010; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Age; Aged; Anesthesia; Apnea; Bariatric Surgery; Biological and medical sciences; Body mass index; Cardiovascular disease; Data processing; Diabetes; Digestive system. Abdomen; Duodenum; Endoscopy; Endoscopy, Gastrointestinal - adverse effects; Endoscopy, Gastrointestinal - methods; Epidemics; Esophagus; Female; Gastroenterology; Gastroesophageal reflux; Gastrointestinal Diseases - diagnosis; Gastrointestinal Diseases - etiology; Gastrointestinal surgery; Gastrointestinal tract; Gynecology; Helicobacter pylori; Hepatology; Humans; Hypoxemia; Infection; Interdisciplinary aspects; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic diseases; Middle Aged; Obesity; Obesity, Morbid - complications; Obesity, Morbid - surgery; Patients; Preoperative Care; Proctology; Propofol; Prospective Studies; Sleep; Sleep apnea; Sleep disorders; Small intestine; Stomach; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Trachea; Working groups; Young Adult; Stomach; Upper gastrointestinal endoscopy; Duodenum; Morbid obesity; Sedation; Upper gastrointestinal pathologies; Esophagus; Human; Endoscopic surgery; Obesity; Esophagogastroduodenoscopy; Nutrition disorder; Bariatric surgery; Gastrointestinal; Gastrointestinal endoscopy; Treatment; Preoperative; Nutritional status
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-010-0893-5

Background Obesity is becoming an epidemic health problem and is associated with concomitant diseases, such as sleep apnea syndrome and gastroesophageal reflux disease (GERD). There is no standardized diagnostic workup for the upper gastrointestinal tract in obese patients; many patients have no upper gastrointestinal symptoms, and few data are available on safety of endoscopy in morbidly obese patients. Methods Sixty-nine consecutive diagnostic upper gastrointestinal endoscopies in morbidly obese patients (26 men, 43 women; mean age 43.4 ± 10.9 years) were prospectively evaluated from January to December 2008 in an outpatient setting before bariatric procedures. Sedation was administered with propofol. Data on sedation, critical events, and examination times were recorded, as well as pathological findings. Results The patients’ mean body mass index was 47.6 ± 7.9 (range, 35.1–73.3) kg/m 2 ; 17.4% reported GERD symptoms. The mean duration of the endoscopy procedure (including sedation) was 20.3 ± 9.3 (range, 5–50) min, and the whole procedure (including preparation and postprocessing) took 58.2 ± 19 (range, 20–120) min. The mean propofol dosage was 380 ± 150 (range, 80–900) mg. Two patients had critical events that required bronchoscopic intratracheal O 2 insufflation due to severe hypoxemia (<60% Sa o 2 ). Nearly 80% of patients had pathological findings in the upper gastrointestinal tract. Only 20% reported upper gastrointestinal symptoms. Pathologic conditions were found in the esophagus in 23.2% of the patients, in the stomach in 78.2%, and in the duodenum in 11.6%. The prevalence of Helicobacter pylori infection was 8.7%. Conclusions Upper gastrointestinal endoscopy can be performed safely. However, careful monitoring and anesthesiological support are required for patients with concomitant diseases and those receiving sedation. Because 80% of the patients with pathological findings were asymptomatic, every morbidly obese patient should undergo endoscopy before bariatric surgery because there may be findings that might change the surgical strategy.