Preoperative Endoscopy Prior to Bariatric Surgery: a Systematic Review and Meta-Analysis of the Literature.
Obes Surg
; 26(12): 2961-2966, 2016 12.
Article
en En
| MEDLINE
| ID: mdl-27198238
ABSTRACT
BACKGROUND:
There is debate regarding preoperative endoscopy (EGD) in patients undergoing bariatric surgery. Some centers perform EGD routinely in all patients; others perform EGD selectively. The objective of this study was to perform a systematic review and meta-analysis of the existing literature to estimate how frequently preoperative EGD changes management.METHODS:
Our review yielded 28 studies encompassing 6616 patients. Baseline characteristics including age and body mass index (BMI) were included. Patients were grouped based on EGD findings into two groups Group 1-findings which did not significantly change management (e.g., mild/moderate duodenitis, Grade A/B esophagitis, mild/moderate gastritis, H. pylori infection, hiatal hernia <2 cm); Group 2-findings which delayed, altered, or cancelled surgery (e.g., severe duodenitis, Grade C/D esophagitis, gastric varices, hiatal hernia >2 cm, mass/carcinoma). A general estimating equation (GEE) model accounting for the correlated data within each study was used to calculate confidence intervals around the estimate of how frequently surgery was delayed or altered.RESULTS:
Mean age was 41.4 ± 2.9 years, the majority was women, and mean preoperative BMI was 47 ± 3.2 kg/m2. Overall 92.4 % (n = 6112) had a normal EGD or findings that did not change clinical management and 7.6 % (n = 504); 95 % CI [4.6, 12.4 %] had findings that delayed/altered surgery. The revised estimate was 20.6 %; 95%CI [14.5, 28.2 %] if all esophagitis (regardless of grade) were categorized into Group 2. The approximate incidence of Barrett's esophagus and carcinoma were 0.1 and 0.08 %, respectively.CONCLUSION:
A selective approach to preoperative EGD may be considered, based on the patients' symptoms, risk factors, and type of procedure planned.Palabras clave
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Banco de datos:
MEDLINE
Asunto principal:
Endoscopía Gastrointestinal
/
Cirugía Bariátrica
/
Enfermedades Gastrointestinales
/
Obesidad
Tipo de estudio:
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Límite:
Adult
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Año:
2016
Tipo del documento:
Article