Selective Versus Routine Preoperative Upper Gastrointestinal Endoscopy in Bariatric Surgery: Impact on Surgical Decision-Making

Abstract

Background:

The role of routine preoperative upper gastrointestinal (GI) endoscopy in bariatric surgery remains controversial. This study aimed to evaluate the prevalence of endoscopic abnormalities and their impact on surgical decision-making.

Methods:

A retrospective analysis was conducted on 360 patients undergoing preoperative upper GI endoscopy prior to bariatric surgery. Demographics, GI symptoms, endoscopic findings, and subsequent changes in surgical planning were evaluated. Statistical analyses included chi-square and independent t-tests.

Results:

Of the 360 patients, 124 (34.4%) were symptomatic and 236 (65.6%) asymptomatic. Endoscopic abnormalities were detected in 215 patients (59.7%). These findings resulted in surgical plan modifications in 118 patients (32.8%).

Symptomatic patients had significantly higher rates of abnormal findings compared with asymptomatic patients (P < .001). Moreover, surgical modifications were significantly more frequent in symptomatic patients (51.6%) than in asymptomatic patients (22.9%) (P < .001).

Conclusions:

Although preoperative endoscopy detects a high rate of abnormalities in bariatric candidates, its clinical impact is predominantly observed in symptomatic patients. This suggests that while endoscopic abnormalities are common, their clinical relevance is predominantly confined to symptomatic patients. A selective, symptom-based approach may therefore be more appropriate than routine endoscopy for all patients.