P1815 - Esophagogastroduodenoscopy Plays an Important Preoperative Role in Bariatric Surgery: Systematic Review and Meta-Analysis

Rami Musallam, MD¹, Syed Hamaad Rahman, DO², Faris Shweikeh, MD³, Azizullah Beran, MD⁴, Babu Mohan, MD, MS⁵, Rania Daaboul, MS⁶, Wasef Sayeh, MD⁷, Pearl Aggarwal, MD⁸, Emad Mansoor, MD⁹, Mohannad Abousaleh, MD¹⁰, C. Roberto Simons-Linares, MD¹¹, Gregory Cooper, MD¹², Ahmed Shamia, MD^11
1Case Western Reserve University School of Medicine, Cleveland, OH; ²Methodist Dallas Medical Center, Dallas, TX; ³Cleveland Clinic Akron General, Akron, OH; ⁴Indiana University, Indianapolis, IN; ⁵University of Utah Health School of Medicine, Salt Lake City, UT; ⁶Oakland University William Beaumont School of Medicine, Farmington Hills, MI; ⁷University of Toledo, Toledo, OH; ⁸University Hospitals St. John Medical Center, Westlake, OH; ⁹Case Western Reserve University / University Hospitals, Cleveland, OH; ¹⁰Huron Gastroenterology, Ann Arbor, MI; ¹¹Cleveland Clinic, Cleveland, OH; ¹²Case Western Reserve/UHCMC, Cleveland, OH

Introduction: The role of preoperative upper gastrointestinal endoscopy before bariatric surgery is still debated, and a consensus among the international scientific community is lacking. Our aim is to analyze data regarding the pathological endoscopic findings and report their impact on the decision-making process and surgical management, in terms of delay in surgical operation, modification of the intended bariatric procedure, or contraindication to surgery.

Methods: We performed a comprehensive search in the databases of PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception through June 2023. Meta-analysis was performed by standard methodology using the random-effects model and heterogeneity was assessed using the I2% statistics. Endoscopic findings were categorized into four groups: (1) normal endoscopy, (2) abnormal findings not requiring a change in the surgical approach, (3) clinically important lesions that required a change in surgical management or further investigations or therapy prior to surgery, and (4) findings that contraindicated surgery.

Results: 46 studies (7 prospective, 39 retrospective) involving 21,135 patients were included with age range of 34-54 years, and 68.3 % were female. The pooled rate of group 1 was 44% [(95% confidence interval (CI): 35.8-52.5%, I2=98.8%); group 2 was 39.3% [95% CI:30.6-48.7%, I2=98.8%]; group 3 was 10.4% [6.8-15.7%, I2=98.4%]; and group 4 was 0.2% [0.1-0.3%, I2=0].

Pooled rates of endoscopic findings included gastritis in 31.1% [25-38%] (erosive gastritis in 12%), hiatus hernia in 16.2% [13.2-19.7%] (≥ 3 cm in 22.6%), reflux esophagitis in 12% [10-14.5%] (15.8% grade B and C), Barret’s esophagus in 1.8% [1.3-2.5%], erosions in 9.2% [6.5-12.9%], polyps 4.8% [3.9-6%], ulcer in 2.4% [1.5-3.8%], upper GI cancer in 0.3% [0.2-0.5], varices in 0.3% [0.2-0.6%] and Helicobacter pylori in 16% [12-21%]. No evidence of publication bias was found (Egger’s test: P=0.11).

Discussion: Our meta-analysis suggests that a large percentage of patients undergoing bariatric surgery have pathologically significant endoscopic findings; this can lead to a change in the planned bariatric procedure in a section of patients; hence, we believe that EGD should be made mandatory as a pre-operative investigation in all bariatric surgery patients. A randomized trial should be performed to validate the usefulness of preoperative EGD in bariatric patients.


Disclosures:


Rami Musallam, MD¹, Syed Hamaad Rahman, DO², Faris Shweikeh, MD³, Azizullah Beran, MD⁴, Babu Mohan, MD, MS⁵, Rania Daaboul, MS⁶, Wasef Sayeh, MD⁷, Pearl Aggarwal, MD⁸, Emad Mansoor, MD⁹, Mohannad Abousaleh, MD¹⁰, C. Roberto Simons-Linares, MD¹¹, Gregory Cooper, MD¹², Ahmed Shamia, MD¹¹. P1815 - Esophagogastroduodenoscopy Plays an Important Preoperative Role in Bariatric Surgery: Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.