Preoperative esophagogastroduodenoscopy findings and effects on laparoscopic Roux-en-Y gastric bypass in area with high prevalence of Helicobacter pylori infection: Multi-center experience in Iran
Gastroenterology and Hepatology from Bed to Bench,
Background and study aim: Esophagogastroduodenoscopy (EGD) and Helicobacter pylori testing are routine parts of preoperative assessment of bariatric surgery at many centers. We aim to evaluate EGD and Helicobacter pylori status affect laparoscopic Roux-en-Y gastric bypass (RYGB) in area with high prevalence of Helicobacter pylori infection.
Patients and methods: This was a cross‑sectional study of all patients underwent EGD before laparoscopic RYGB in three gastroenterology centers in Iran between January 2018 and December 2020. All patients were diagnosed to be Helicobacter pylori status by histopathological examination.
Results: 637 patients (52.4% female) were enrolled in this study. 46.8% of patients had any abnormal mucosal appearance. In 0.6%, surgery was canceled (esophageal varices, gastric malignancies). 1.7% needed endoscopic intervention (gastric polyps and bezoars) and 11.9% needed medical management (severe esophagitis, peptic ulcer disease, erosive gastritis/ duodenitis). The prevalence of H. pylori was 61.5% and there was no statistical difference in the prevalence in groups of normal and abnormal EGD. 88.8% of patients with normal mucosal appearance in EGD were asymptomatic and 92.6% in group with abnormal EGD were symptomatic (p=0.01). Without considering H. pylori status, EGD could just influence in 13.7% surgery time and 0.6% surgery canceling.
Conclusion: Even with considering high H. pylori prevalence in Iran, using EGD as a routine investigation in the preoperative assessment for RYGB surgery would not have a significant impact. If clinically symptoms and/or signs are present, the patient should go through an appropriate evaluation with EGD.
- Gastric bypass surgery; esophagogastroduodenoscopy; Helicobacter pylori.
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