P1952 - Routine Screening Endoscopy Prior to Bariatric Surgery - A Case Series

Mark J. Radlinski, MD¹, Amy Doran, MD², Courtney Schempp, RN^2
1University of Virginia Digestive Health Center, Charlottesville, VA; ²University of Virginia, Charlottesville, VA

Introduction: Screening esophagogastroduodenoscopy (EGD) in asymptomatic patients prior to bariatric surgery is a point of controversy in the literature. Current ASGE guidelines (2015) suggest that performance of preoperative EGD should be “individualized to the patients” undergoing bariatric surgery with input from the surgeon and consideration of the preferred bariatric procedure. An EGD can help to identify many conditions (e.g. Barrett’s esophagus, gastroesophageal reflux disease, hiatal hernia , polyps, etc.) that may alter the surgical approach. Recent literature has called into question the utility of this exam as surgical management is often not altered, even in the presence of endoscopic abnormalities. We present a case series of patients undergoing screening EGD prior to bariatric surgery for which the endoscopic findings directly impacted the surgical plan.

Case Description/Methods: An asymptomatic 68-year-old woman had endoscopic findings of a large paraesophageal hernia. The patient underwent paraesophageal hernia repair along with Roux-en-y gastric bypass. (A)



An asymptomatic 32-year-old man had endoscopic findings of Los Angeles grade A esophagitis with gastric ulcerations. Gastric biopsies were consistent with chronic inactive gastritis with chemical gastropathy. The patient underwent sleeve gastrectomy for surveillance purposes. (B)



An asymptomatic 50-year-old woman had endoscopic findings of type 1 gastric varices (GOV1) in the fundus. The patient underwent sleeve gastrectomy for surveillance purposes. (C)



An asymptomatic 51-year-old woman had endoscopic findings of diffusely erythematous gastric mucosa with pathology indicative of chronic inflammation (H.Pylori negative). A sleeve gastrectomy is planned for surveillance purposes. (D)



An asymptomatic 31-year-old woman had endoscopic findings of an ampullary villous deformity. Biopsies showed chronic inflammatory and reactive changes. A sleeve gastrectomy was pursued for ampullary surveillance. (E)

Discussion: Abnormal findings can be found in up to 61.6% of asymptomatic patients during pre-screening EGD. The literature varies on the percentage of cases where these findings altered surgical management, ranging between 1% and 9%. Healthcare costs and delays in surgery have been cited as reasons to forgo screening. It is evident that there are asymptomatic patients where surgical planning will be altered based on endoscopic findings (as opposed to other screening modalities).



Disclosures:


Mark J. Radlinski, MD¹, Amy Doran, MD², Courtney Schempp, RN². P1952 - Routine Screening Endoscopy Prior to Bariatric Surgery - A Case Series, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.