Portal de Periódicos da CAPES

Frequency of Upper Endoscopy and Endoscopic Findings in Bariatric Surgery (BS) Patients By Type of Surgery and Surgical Technique

2006; Elsevier BV; Volume: 63; Issue: 5 Linguagem: Inglês

10.1016/j.gie.2006.03.302

1097-6779

Michael J. Nosler, Richard Gilroy, Corrigan L. McBride,

Hypertrophic osteoarthropathy and related conditions

Introduction/Background: The pool of candidates for BS is expected to increase by 10-12%/year. Roughly 200,000 BS will be performed in 2005. 10% to 20% of these patients suffer symptoms after surgery, frequently requiring endoscopic evaluation (EGD). The frequency of postoperative EGD and the endoscopic findings in this growing population have not been well described. Methods: We analyzed our prospectively collected database for all BS patients since January 2001. We evaluated patient demographics, date and type of surgery, surgical technique, indication for EGD, endoscopic findings, interventions employed, and need for repeat EGD. Results: 752 BS were performed: Bilio-pancreatic Diversions = 101, Roux-en-Y Gastric Bypass (RYGB) = 578, LapBand® = 62, Jejuno-ileal Bypass = 11. 135 patients (18.0%) were referred for EGD (11.9% of BPD, 9.7% of LGB, and 10.2% of RYGB); a total of 230 EGDs were performed. Indications were dyspepsia (N = 58, 42.9%), nausea or vomiting (N = 48, 35.6%), melena (N = 7, 5.2%), hematemesis (N = 4, 4.4%), anemia (N = 3, 2.2%), chest pain (N = 2, 1.5%) all others (N = 11, 8.2%). Our overall incidence of normal EGDs was 5.6%, marginal ulcer was 5.3% and anastomotic stenosis was 3.5%. The diagnoses were normal (N = 42, 31.1%), marginal ulcer (N = 40, 29.6%), anastomotic stenosis (N = 26, 19.3%), visible suture (N = 9, 6.7%), gastric ulcer (N = 4, 2.9%), other (N = 14, 10.4%). Of those with dyspepsia 39.7% = normal, 37.9% = marginal ulcer, and 12% = staple or suture. Of those with nausea or vomiting 50% = anastomotic stenosis, 20% = normal, and 18% = marginal ulcer. 48/135 (35.6%), required multiple EGDs. Of these, 20/48 had anastomotic stenosis and 20/48 had marginal ulcer. Of those with stenosis, 69.2% required 2 or more dilations. Overall 24 required 2 EGDs, 9 required 3, 15 required >3. For all RYGB (N = 578) the incidence of marginal ulcer = 6.2%, normal = 6.1%, anastomotic stenosis = 4.5%, visible staple or suture = 1.6%, all other < 1%. For laparoscopic RYGB (N = 301), the incidence of marginal ulcer = 9.3%, normal = 4.9%, anastomotic stenosis = 4.3%, visible staple or suture 2.7%. For all open RYGB (N = 277) marginal ulcer was diagnosed in 2.9%, anastomotic stenosis 4.7%. For all laparoscopic RYGB referred for EGD, marginal ulcer was diagnosed in 40%, anastomotic stenosis in 18.6%. For open RYGB referred for EGD, marginal ulcer was diagnosed in 17%, and anastomotic stenosis in 27.7%. Conclusion: Post-operative symptoms prompting EGD for the BS patient are common. Endoscopic findings vary based on operation and approach. It is important that the endoscopist is familiar with surgical technique, potential endoscopic findings, and is prepared for multiple EGDs.