GuidelineRole of endoscopy in the bariatric surgery patient
Section snippets
Background
Obesity in the United States is a major health problem that contributes to increased morbidity and mortality and to a host of disease processes.1, 2 Body mass index (BMI) is calculated as weight/height2 (kg/m2) and is commonly used to classify overweight (BMI 25.0-29.9 kg/m2) and obese (BMI ≥30.0 kg/m2) adults. Based on data obtained from the National Health and Nutrition Examination Survey from 2003 to 2004, 61% of adults over the age of 20 years in the United States are overweight or obese,
Evaluation of the preoperative patient
The role of upper endoscopy in the preoperative evaluation of patients undergoing bariatric surgery may be based, in part, on the presence or absence of symptoms. The performance of an upper endoscopy in a patient with reflux symptoms, dysphagia, and/or dyspepsia has been covered in recent guidelines and is equally relevant in the preoperative patient.13, 14 However, because RYGB and DS/BPD render the distal stomach and/or duodenum inaccessible by a standard upper endoscope, the threshold for
General principles
When an endoscopy is considered in a patient who had bariatric surgery, the endoscopist should be aware of the operative procedure performed and the findings on preprocedural imaging studies, and must understand the expected anatomy, including the extent of resection and the length of surgically created limbs. Direct communication with the surgeon, if possible, is advisable. Feitoza and Baron26 published a detailed review of endoscopy in patients with postsurgical anatomy, including information
Symptoms
Nausea, vomiting, and abdominal pain are among the most commonly encountered symptoms after bariatric surgery and may result from one or several structural and functional etiologies. Symptoms are frequently associated with dietary noncompliance as to the volume and type of foods eaten, rapid ingestion, or inadequate chewing. Patients with persistent symptoms, despite counseling and behavior modification, should be evaluated, because these symptoms may indicate the development of marginal
Summary and recommendations
Bariatric surgical intervention presents new challenges to the endoscopist:
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An upper endoscopy should be performed in all patients with upper-GI–tract symptoms who are to undergo bariatric surgery. (Level 2C)
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Upper endoscopy should be considered in all patients who are to undergo an RYGB, regardless of the presence of symptoms. (Level 3)
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In patients without symptoms and who are not undergoing an endoscopy, noninvasive H pylori testing followed by treatment, if positive, is recommended. (Level 3)
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In
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This document is a product of the Standards of Practice Committee. This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.
This document was reviewed and endorsed by the SAGES Guidelines Committee and Board of Governors.