Pre-operative work-up before bariatric surgery: Should ultrasonography and upper gastrointestinal endoscopy be done routinely?

Abstract

Aim: The objective of this research was to clarify whether routine upper gastrointestinal endoscopy and abdominal ultrasound examination before bariatric surgery affect the surgical plan in our bariatric center. Material and Methods: Bariatric surgery was performed in 320 patients between January 2015 and February 2018 in our bariatric center. The files of 185 patients who underwent upper abdominal ultrasonography and upper endoscopy in the preoperative workup period were assessed retrospectively. Collected data; age, gender, BMI before operation, sonographic findings, endoscopic findings, and subsequent follow-up plan. The patients were seperated into four groups regarding sonographic and upper endoscopy findings. Results: The mean age of the participants was 41.01, 65 (35.1%) were female and 120 (63.9%) were male. The mean BMI was 42.2 kg/m2 . Ultrasound was found normal in 75 participants (40.5%) and one or multipl abnormal findings were detected in 110 patients (59.5%). The procedure was delayed or canceled for patients (2.1%) according to the sonographic findings which required workup and treatment before surgery. Normal endoscopy without findings appeared in 47 participants (25.4%) while one or more abnormal findings was appeared in 138 patients (74.6%). Patients who had serious esophagitis, gastroesophageal reflux disease, grade D esophagitis or wide hiatus hernias were treated on regime change and proton pump inhibitor drugs but these circumstances were contemplated to be an evaluation for gastric bypass and a inappropriate for sleeve gastrectomy. Conclusions: Ultrasound findings affected the offered surgical timing in 3 (2.1%) of 185 patients reviewed and should be reserved for symptomatic patients only. Depending on the abnormal abnormalities in the gastroscopy, the procedure was canceled, altered or deferred at 48.4%. We suggest that endoscopy should be performed routinely in light of these results.